To the Editor.
—Cole and Aubé1 suggested that, in severe migraine attacks, vasospasm may result in ischemic necrosis of intracranial vessel walls, leading to a subsequent vessel rupture responsible for delayed lobar intracerebral hemorrhage, when perfusion pressure is restored. They stated that, except migraine, "sub-arachnoid hemorrhage, cerebral trauma, central nervous system infection, drug abuse, toxemia, fibromuscular dysplasia, carotid artery dissection, and cerebral vasculitis have all been associated with the radiographic appearance of spasm of the cerebral arteries." Another possible cause for vasospasm is cerebral embolism. We recently described rupture of the arterial wall in two cases of cerebral embolism.2 One patient suffered a frontal hematoma. As proposed by Villaret et al,3 arterial spasm may have occurred at the time of cerebral embolism. The morphological expressions specific to cerebral vasospasm are unknown. Cole and Aubé1 suggested rupture of the arterial wall, secondary to ischemic necrosis. We2
De Smet Y, Brucher JM. Migraine With Vasospasm and Delayed Intracerebral Hemorrhage. Arch Neurol. 1991;48(1):17. doi:10.1001/archneur.1991.00530130025004
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