Understanding post-traumatic vasospasm as a hidden complication of traumatic brain injury

A new review published in the Journal of Intensive Medicine on 25 July, 2025 and led by Dr. Alice Jacquens and Dr. Clara Perrault from Pitié Salpêtrière Hospital, Paris, France, sheds light on an under-recognized complication of traumatic brain injury (TBI): post-traumatic vasospasm (PTV).

PTV is a sudden narrowing of brain arteries that can lead to stroke and long-term neurological damage. It may affect up to 60% of TBI patients but is often missed, especially in intensive care units where patients are sedated or in a coma. Unlike vasospasm after brain aneurysms, PTV occurs earlier, resolves faster, and may follow various patterns depending on the type of trauma.

The review summarizes current knowledge on PTV's causes, detection, and treatments. Key tools like transcranial Doppler ultrasound and S100 protein blood tests can help with early diagnosis. Treatment options include nimodipine and intra-arterial milrinone, though evidence is limited and more studies are needed.

The authors call for systematic monitoring of vasospasm after TBI and propose a classification of PTV based on trauma type. They also explore specific biological mechanisms involving inflammation, blood degradation products, and vasoconstrictors like endothelin-1.

"Post-traumatic vasospasm is often silent but dangerous," says Dr. Jacquens. "Recognizing it early can help prevent secondary brain injury."

With millions of TBIs occurring each year, this work highlights the urgent need for greater clinical awareness and focused research.