Near-complete resolution of angiographic cerebral vasospasm after extreme elevation of mean arterial pressure: case report.
BACKGROUND
Cerebral vasospasm is a widespread and potentially treatable complication after aneurysmal SAH. Aggressive treatment often includes hemodynamic augmentation, although the exact mechanism by which such therapy leads to improved cerebral blood flow and reduced neurologic deficits is incompletely established. This case report is only the second to provide compelling evidence that hypertension can lead to direct dilation of vasospastic arteries, thereby providing valuable insight into its potential mechanism.


METHODS
We present a patient with SAH from a ruptured anterior communicating artery aneurysm who developed marked decline in mental status on posthemorrhage day 11, consistent with symptomatic cerebral vasospasm. A diagnostic cerebral angiogram was performed demonstrating extensive and diffuse cerebral vasospasm. After receiving a nonselective slow infusion of verapamil, the patient developed an episode of extreme hypertension. Repeat angiography immediately after hypertensive crisis revealed near-complete resolution of the previously noted cerebral vasospasm. Rapid improvement in the patient's neurologic status ensued.


CONCLUSIONS
The present case illustrates that extreme hypertension can lead to direct dilation of vasospastic arteries and suggests that hypertensive-type hemodynamic therapy may act not only through increasing the pressure gradient across vasospastic arteries but also via direct induction of arterial vasodilation.
Ray
Wilson Z
WZ
Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. rayz@nsurg.wustl.edu
Moran
Christopher J
CJ
Derdeyn
Colin P
CP
Diringer
Michael N
MN
Dacey
Ralph G
RG
Zipfel
Gregory J
GJ
D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D020925:Hypoxia-Ischemia, Brain / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D002532:Intracranial Aneurysm / Q000150:complications; D008875:Middle Aged; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D014700:Verapamil / Q000494:pharmacology* / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D014700:Verapamil