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

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dc.contributor.authorZeiler, F. A.
dc.contributor.authorSilvaggio, J.
dc.date.accessioned2015-09-21T14:22:52Z
dc.date.available2015-09-21T14:22:52Z
dc.date.issued2015-9-17
dc.date.updated2015-09-19T06:59:20Z
dc.description.abstractBackground. 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.
dc.description.versionPeer Reviewed
dc.identifier.citationF. A. Zeiler and J. Silvaggio, “Early Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy,” Case Reports in Critical Care, vol. 2015, Article ID 164597, 5 pages, 2015. doi:10.1155/2015/164597
dc.identifier.urihttp://dx.doi.org/10.1155/2015/164597
dc.identifier.urihttp://hdl.handle.net/1993/30837
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderCopyright © 2015 F. A. Zeiler and J. Silvaggio. 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.titleEarly Angiographic Resolution of Cerebral Vasospasm with High Dose Intravenous Milrinone Therapy
dc.typeJournal Article
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