Intra-arterial calcium channel blocker infusion for treatment of severe vasospasm in traumatic brain injury: case report.
OBJECTIVE
The authors describe a case of severe traumatic arterial vasospasm and its subsequent management using angiography and multiple infusions of calcium channel blockers.


METHODS
A 26-year-old man presented with subarachnoid hemorrhage and an initial Glasgow Coma Scale score of 4 after a motor vehicle accident. The patient underwent a bifrontal craniotomy and right frontal decompressive craniectomy for bilateral frontal epidural and subdural hematomas secondary to subarachnoid hemorrhage.


METHODS
While the patient was in the intensive care unit, severe vasospasm developed, as documented by transcranial Doppler ultrasonography, cerebral blood flow monitoring, and angiography. The patient was treated on 3 separate days with either nicardipine or verapamil infusions during angiography. After each infusion, the middle cerebral artery diameter improved (diameter increased 23.1-60.5%). The arterial vasospasm eventually resolved after 22 days, and the patient was discharged to acute rehabilitation. Four months after discharge, the patient had a Barthel index of 90 and has relatively slow speech but was able to ambulate without assistance and follow complex commands.


CONCLUSIONS
To our knowledge, this is the first reported case of multiple intra-arterial calcium channel blocker infusions for severe posttraumatic vasospasm, as assessed by transcranial Doppler ultrasonography, cerebral blood flow monitoring, and angiography. This case reinforces that arterial vasospasm does occur in response to traumatic brain injury and further demonstrates that treatment with calcium channel blocker infusions is associated with angiographic changes and a subsequent reversal of ischemic blood flow.
Lee
Darrin J
DJ
Division of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-7039, USA.
Moftakhar
Parham
P
Glenn
Thomas C
TC
Vespa
Paul M
PM
Martin
Neil A
NA
D000063:Accidents, Traffic; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D002533:Cerebral Angiography; D020202:Cerebral Hemorrhage, Traumatic / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000187:drug effects; D019299:Decompression, Surgical; D015600:Glasgow Coma Scale; D006801:Humans; D007261:Infusions, Intra-Arterial; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D009529:Nicardipine / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014654:Vascular Patency / Q000187:drug effects; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology*; D014700:Verapamil / Q000008:administration & dosage
D002121:Calcium Channel Blockers; D014700:Verapamil; D009529:Nicardipine