title: Complications associated with intraarterial administration of papaverine for vasospasm following subarachnoid hemorrhage--two case reports.
abstract: Complications associated with intraarterial papaverine infusion occurred in two patients treated for vasospasm due to subarachnoid hemorrhage (SAH). A 42-year-old male with an anterior communicating artery aneurysm underwent craniotomy and aneurysm clipping. Five days after the SAH occurred, angiography demonstrated moderate vasospasm in spite of hypervolemic-hypertensive therapy. During papaverine infusion into the carotid artery, he suffered loss of consciousness due to a seizure for a few minutes. A 61-year-old female with a right internal carotid-posterior communicating artery aneurysm underwent clipping. Six days after the SAH occurred, angiography demonstrated severe vasospasm in spite of hypervolemic-hypertensive therapy. Angiography performed immediately after papaverine infusion into the carotid artery revealed exacerbation of the vasospasm. Finally she suffered cerebral infarction and died. Complications of intraarterial papaverine infusion are potentially dangerous. We recommend trial administration of papaverine with angiography and neurological examination before full dose infusion to avoid complications.
authors.affiliation: Department of Neurosurgery, Ibaraki Seinam Medical Center Hospital, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tsurushima
authors.forename: T
authors.initials: T
authors.lastname: Kamezaki
authors.forename: Y
authors.initials: Y
authors.lastname: Nagatomo
authors.forename: A
authors.initials: A
authors.lastname: Hyodo
authors.forename: T
authors.initials: T
authors.lastname: Nose
mesh_terms: D000328:Adult; D002339:Carotid Arteries; D002533:Cerebral Angiography; D003399:Craniotomy / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007431:Intraoperative Complications / Q000139:chemically induced / Q000188:drug therapy; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*; D020301:Vasospasm, Intracranial / Q000139:chemically induced* / Q000188:drug therapy* / Q000209:etiology
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine