Norepinephrine as a Potential Aggravator of Symptomatic Cerebral Vasospasm: Two Cases and Argument for Milrinone Therapy

Simple item page
dc.contributor.authorZeiler, F. A.
dc.contributor.authorSilvaggio, J.
dc.contributor.authorKaufmann, A. M.
dc.contributor.authorGillman, L. M.
dc.contributor.authorWest, M.
dc.date.accessioned2015-05-14T16:08:43Z
dc.date.available2015-05-14T16:08:43Z
dc.date.issued2014-11-9
dc.date.updated2015-03-29T13:26:28Z
dc.description.abstractBackground. During hypertensive therapy for post-subarachnoid hemorrhage (SAH) symptomatic vasospasm, norepinephrine is commonly used to reach target blood pressures. Concerns over aggravation of vasospasm with norepinephrine exist. Objective. To describe norepinephrine temporally related deterioration in neurological examination of two post-SAH patients in vasospasm. Methods. We retrospectively reviewed two charts of patients with delayed cerebral ischemia (DCI) post-SAH who deteriorated with norepinephrine infusions. Results. We identified two patients with DCI post-SAH who deteriorated during hypertensive therapy with norepinephrine. The first, a 43-year-old male presented to hospital with DCI, failed MABP directed therapy with rapid deterioration in exam with high dose norepinephrine and MABP of 140–150 mm Hg. His exam improved on continuous milrinone and discontinuation of norepinephrine. The second, a 39-year-old female who developed DCI on postbleed day 8 responded to milrinone therapy upfront. During further deterioration and after angioplasty, norepinephrine was utilized to drive MABP to 130–140 mm Hg. Progressive deterioration in examination occurred after angioplasty as norepinephrine doses escalated. After discontinuation of norepinephrine and continuation of milrinone, function dramatically returned but not to baseline. Conclusions. The potential exists for worsening of DCI post-SAH with hypertensive therapy directed by norepinephrine. A potential role exists for vasodilation and inotropic directed therapy with milrinone in the setting of DCI post-SAH.
dc.description.versionPeer Reviewed
dc.identifier.citationF. A. Zeiler, J. Silvaggio, A. M. Kaufmann, L. M. Gillman, and M. West, “Norepinephrine as a Potential Aggravator of Symptomatic Cerebral Vasospasm: Two Cases and Argument for Milrinone Therapy,” Case Reports in Critical Care, vol. 2014, Article ID 630970, 5 pages, 2014. doi:10.1155/2014/630970
dc.identifier.urihttp://dx.doi.org/10.1155/2014/630970
dc.identifier.urihttp://hdl.handle.net/1993/30472
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderCopyright © 2014 F. A. Zeiler et al. 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.
dc.titleNorepinephrine as a Potential Aggravator of Symptomatic Cerebral Vasospasm: Two Cases and Argument for Milrinone Therapy
dc.typeJournal Article
Files
Original bundle
Now showing 1 - 2 of 2
Thumbnail Image
Name:
CRICC.2014.630970.xml
Size:
7.71 KB
Format:
Extensible Markup Language
Description:
Download
Thumbnail Image
Name:
CRICC.2014.630970.pdf
Size:
483.36 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
2.27 KB
Format:
Item-specific license agreed to upon submission
Description:
Download
Collections
University of Manitoba Scholarship
Rady Faculty of Health Sciences Scholarly Works