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Continuous intra-arterial nimodipine infusion in refractory symptomatic vasospasm after subarachnoid hemorrhage. 2016

Raimund Helbok, and Alexandra Zangerle, and Andreas Chemelli, and Ronny Beer, and Thomas Benke, and Rainer Ehling, and Marlene Fischer, and Martin Sojer, and Bettina Pfausler, and Claudius Thome, and Erich Schmutzhard
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.

BACKGROUND Vasospasm still is a major cause of morbidity after aneurysmal subarachnoid hemorrhage. The purpose of this report is to describe the successful management of severe refractory vasospasm with continuous intra-arterial nimodipine (IAN) treatment. METHODS A 72-year old right handed woman was admitted with non-traumatic SAH WFNS grade 1. Cerebral computed tomography demonstrated thick blood filling of the basal cisterns, and intraventricular hemorrhage. Cerebral angiogram failed to detect a vascular abnormality. After an uneventful initial course the patient developed symptomatic left middle cerebral artery vasospasm with aphasia and corresponding restriction in diffusion weighted images in the left frontal lobe. Bolus IAN only transiently improved cerebral circulation and clinical signs and symptoms. Continuous-IAN was started and led to full clinical recovery and normalisation of MRI diffusion restrictions. CONCLUSIONS Continuous selective intra-arterial infusion of nimodipine may be an option in selected patients with symptomatic vasospasm refractory to conventional treatment after careful consideration of benefits and procedure-related risks.

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