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Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy

Background. Treatment of symptomatic delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult. Recent studies suggest intravenous (IV) high dose milrinone as a potential therapy. The timing to angiographic response with this is unclear. Methods. We reviewed the chart of one p...

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Autores principales: Zeiler, F. A., Silvaggio, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589610/
https://www.ncbi.nlm.nih.gov/pubmed/26457209
http://dx.doi.org/10.1155/2015/164597
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author Zeiler, F. A.
Silvaggio, J.
author_facet Zeiler, F. A.
Silvaggio, J.
author_sort Zeiler, F. A.
collection PubMed
description Background. Treatment of symptomatic delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult. Recent studies suggest intravenous (IV) high dose milrinone as a potential therapy. The timing to angiographic response with this is unclear. Methods. We reviewed the chart of one patient admitted for SAH who developed symptomatic DCI and was treated with high dose IV milrinone. Results. A 66-year-old female was admitted with a Hunt and Hess clinical grade 4, World Federation of Neurological Surgeons (WFNS) clinical grade 4, and SAH secondary to a left anterior choroidal artery aneurysm which was clipped. After bleed day 6, the patient developed symptomatic DCI. We planned for angioplasty of the proximal segments. We administered high dose IV milrinone bolus followed by continuous infusion which led to clinical improvement prior to angiography. The angiogram performed 1.5 hours after milrinone administration displayed resolution of the CT angiogram and MRI based cerebral vasospasm such that further intra-arterial therapy was aborted. She completed 6 days of continuous IV milrinone therapy, was transferred to the ward, and subsequently rehabilitated. Conclusions. High dose IV milrinone therapy for symptomatic DCI after SAH can lead to rapid neurological improvement with dramatic early angiographic improvement of cerebral vasospasm.
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spelling pubmed-45896102015-10-11 Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy Zeiler, F. A. Silvaggio, J. Case Rep Crit Care Case Report Background. Treatment of symptomatic delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult. Recent studies suggest intravenous (IV) high dose milrinone as a potential therapy. The timing to angiographic response with this is unclear. Methods. We reviewed the chart of one patient admitted for SAH who developed symptomatic DCI and was treated with high dose IV milrinone. Results. A 66-year-old female was admitted with a Hunt and Hess clinical grade 4, World Federation of Neurological Surgeons (WFNS) clinical grade 4, and SAH secondary to a left anterior choroidal artery aneurysm which was clipped. After bleed day 6, the patient developed symptomatic DCI. We planned for angioplasty of the proximal segments. We administered high dose IV milrinone bolus followed by continuous infusion which led to clinical improvement prior to angiography. The angiogram performed 1.5 hours after milrinone administration displayed resolution of the CT angiogram and MRI based cerebral vasospasm such that further intra-arterial therapy was aborted. She completed 6 days of continuous IV milrinone therapy, was transferred to the ward, and subsequently rehabilitated. Conclusions. High dose IV milrinone therapy for symptomatic DCI after SAH can lead to rapid neurological improvement with dramatic early angiographic improvement of cerebral vasospasm. Hindawi Publishing Corporation 2015 2015-09-17 /pmc/articles/PMC4589610/ /pubmed/26457209 http://dx.doi.org/10.1155/2015/164597 Text en Copyright © 2015 F. A. Zeiler and J. Silvaggio. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Zeiler, F. A.
Silvaggio, J.
Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
title Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
title_full Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
title_fullStr Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
title_full_unstemmed Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
title_short Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
title_sort early angiographic resolution of cerebral vasospasm with high dose intravenous milrinone therapy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589610/
https://www.ncbi.nlm.nih.gov/pubmed/26457209
http://dx.doi.org/10.1155/2015/164597
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