The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage.
BACKGROUND
Traumatic subarachnoid hemorrhage (SAH) is a common intracranial lesion after traumatic brain injury (TBI). As in aneurysmal SAH, cerebral vasospasm is a common cause of secondary brain injury and is associated with the thickness of traumatic SAH. Unfortunately, there is limited literature on an effective treatment of this entity. The vasodilatory and inotropic agent, Milrinone, has been shown to be effective in treating vasospasm following aneurysmal SAH. The authors hypothesized that this agent could be useful and safe in treating vasospasm following tSAH.


METHODS
Case reports of 2 TBI cases from a level 1 trauma centre with tSAH and whom developed delayed ischemic neurological deficits (DINDs) are presented. Intravenous Milrinone treatment was provided to each patient following the "Montreal Neurological Hospital Protocol".


RESULTS
Both patients had an improvement in their DINDs following the treatment protocol. There were no complications of treatment and the Glasgow Outcome Scores of the patients ranged from 4 to 5.


CONCLUSIONS
This is the first report of the use of intravenous Milrinone to treat cerebral vasospasm following traumatic SAH. This treatment option appeared to be safe and potentially useful at treating post-traumatic vasospasm. Prospective studies are necessary to establish Milrinone's clinical effectiveness in treating this type of cerebral vasospasm.
Department of Neurology and Neurosurgery, McGill University Health Centre, 1650 Cedar Ave., room L7-516, H3G 1A4 Montreal, QC Canada.
Oliver
O
Lasry
Department of Neurology and Neurosurgery, McGill University Health Centre, 1650 Cedar Ave., room L7-516, H3G 1A4 Montreal, QC Canada.
Judith
J
Marcoux
Milrinone; Post-traumatic vasospasm; Subarachnoid hemorrhage; Traumatic brain injury; Vasospasm