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Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report
Reversible cerebral vasoconstriction syndrome (RCVS) is a poorly understood but increasingly recognized entity, likely multifactorial in nature and characterized by diffuse cerebral vasospasm that presents as sudden, intense, and fluctuating headaches. Due to insufficient evidence, there is currentl...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440144/ https://www.ncbi.nlm.nih.gov/pubmed/37605668 http://dx.doi.org/10.7759/cureus.42269 |
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author | Wakefield, Colin Ngo, Brendon Naydin, Stanislav Rahme, Rudy Binning, Mandy |
author_facet | Wakefield, Colin Ngo, Brendon Naydin, Stanislav Rahme, Rudy Binning, Mandy |
author_sort | Wakefield, Colin |
collection | PubMed |
description | Reversible cerebral vasoconstriction syndrome (RCVS) is a poorly understood but increasingly recognized entity, likely multifactorial in nature and characterized by diffuse cerebral vasospasm that presents as sudden, intense, and fluctuating headaches. Due to insufficient evidence, there is currently no consensus on RCVS treatment guidelines. However, nicardipine, an L-type calcium channel blocker, may prove effective in RCVS treatment because of its ability to penetrate the blood-brain barrier. We report the concomitant use of intrathecal (IT) nicardipine and continuous intraarterial (IA) nicardipine infusion via microcatheter placed in the intracranial circulation for the treatment of a 58-year-old female with severe refractory RCVS. On presentation, this patient was noted to have a non-traumatic non-aneurysmal subarachnoid hemorrhage secondary to RCVS. Initially managed with oral verapamil, she later developed refractory symptomatic vasoconstriction requiring multiple angiograms for spasmolysis via balloon angioplasty and IA nicardipine. Due to the refractory nature of her spasm despite the IA therapy, we decided to attempt intrathecal nicardipine, starting at 4 mg q12 h via an external ventricular drain. This dose was escalated to 4 mg q6 h. The patient stabilized for 24 h but again decompensated, requiring continuous IA spasmolysis via a microcatheter placed in the left middle cerebral artery and left for continuous IA nicardipine infusion (5 mg/h). The patient showed slow incremental improvement clinically and a decrease in vasospasms on imaging, ultimately suffering minimal stroke burden. This patient's hospital course demonstrates that nicardipine, administered intrathecally or intraarterially, could be beneficial in select patients with refractory RCVS as a means of minimizing repeat angiography/angioplasty. Further studies are needed to better define a treatment paradigm for these patients. |
format | Online Article Text |
id | pubmed-10440144 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-104401442023-08-21 Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report Wakefield, Colin Ngo, Brendon Naydin, Stanislav Rahme, Rudy Binning, Mandy Cureus Neurology Reversible cerebral vasoconstriction syndrome (RCVS) is a poorly understood but increasingly recognized entity, likely multifactorial in nature and characterized by diffuse cerebral vasospasm that presents as sudden, intense, and fluctuating headaches. Due to insufficient evidence, there is currently no consensus on RCVS treatment guidelines. However, nicardipine, an L-type calcium channel blocker, may prove effective in RCVS treatment because of its ability to penetrate the blood-brain barrier. We report the concomitant use of intrathecal (IT) nicardipine and continuous intraarterial (IA) nicardipine infusion via microcatheter placed in the intracranial circulation for the treatment of a 58-year-old female with severe refractory RCVS. On presentation, this patient was noted to have a non-traumatic non-aneurysmal subarachnoid hemorrhage secondary to RCVS. Initially managed with oral verapamil, she later developed refractory symptomatic vasoconstriction requiring multiple angiograms for spasmolysis via balloon angioplasty and IA nicardipine. Due to the refractory nature of her spasm despite the IA therapy, we decided to attempt intrathecal nicardipine, starting at 4 mg q12 h via an external ventricular drain. This dose was escalated to 4 mg q6 h. The patient stabilized for 24 h but again decompensated, requiring continuous IA spasmolysis via a microcatheter placed in the left middle cerebral artery and left for continuous IA nicardipine infusion (5 mg/h). The patient showed slow incremental improvement clinically and a decrease in vasospasms on imaging, ultimately suffering minimal stroke burden. This patient's hospital course demonstrates that nicardipine, administered intrathecally or intraarterially, could be beneficial in select patients with refractory RCVS as a means of minimizing repeat angiography/angioplasty. Further studies are needed to better define a treatment paradigm for these patients. Cureus 2023-07-21 /pmc/articles/PMC10440144/ /pubmed/37605668 http://dx.doi.org/10.7759/cureus.42269 Text en Copyright © 2023, Wakefield et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Neurology Wakefield, Colin Ngo, Brendon Naydin, Stanislav Rahme, Rudy Binning, Mandy Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report |
title | Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report |
title_full | Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report |
title_fullStr | Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report |
title_full_unstemmed | Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report |
title_short | Intrathecal Nicardipine for Severe Intractable Reversible Cerebral Vasoconstriction Syndrome: A Novel Case Report |
title_sort | intrathecal nicardipine for severe intractable reversible cerebral vasoconstriction syndrome: a novel case report |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440144/ https://www.ncbi.nlm.nih.gov/pubmed/37605668 http://dx.doi.org/10.7759/cureus.42269 |
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