Fig. 12. Treatment of cerebral vasospasm with intracarotid verapamil. A 57-yr-old woman developed sudden severe headache and collapsed to the floor. On admission to the hospital emergency department, she was comatose with decorticate posturing. (  A ) Computed tomographic brain scan without contrast demonstrates diffuse subarachnoid hemorrhage (  arrow ). (  B and  C ) Cerebral arteriography demonstrates a 7-mm left posterior communicating artery aneurysm (  arrow ). There is no spasm in the cerebral arteries at the time of initial presentation. (  D ) Surveillance arteriography on day 7 after the hemorrhage shows moderate to severe, flow-limiting spasm of the cerebral arteries (  arrows ). (  E ) To prevent stroke, endovascular treatment including balloon angioplasty (  arrow ) followed by vasodilator infusion therapy with 5 mg verapamil was performed. (  F ) Cerebral arteriography after treatment shows both improved vessel dimension and flow in the cerebral vasculature. Images and case history are provided by Phillip M. Meyers, M.D.