Continuous intra-arterial nimodipine infusion in refractory symptomatic vasospasm after subarachnoid hemorrhage.
BACKGROUND
Vasospasm still is a major cause of morbidity after aneurysmal subarachnoid hemorrhage. The purpose of this report is to describe the successful management of severe refractory vasospasm with continuous intra-arterial nimodipine (IAN) treatment.


METHODS
A 72-year old right handed woman was admitted with non-traumatic SAH WFNS grade 1. Cerebral computed tomography demonstrated thick blood filling of the basal cisterns, and intraventricular hemorrhage. Cerebral angiogram failed to detect a vascular abnormality. After an uneventful initial course the patient developed symptomatic left middle cerebral artery vasospasm with aphasia and corresponding restriction in diffusion weighted images in the left frontal lobe. Bolus IAN only transiently improved cerebral circulation and clinical signs and symptoms. Continuous-IAN was started and led to full clinical recovery and normalisation of MRI diffusion restrictions.


CONCLUSIONS
Continuous selective intra-arterial infusion of nimodipine may be an option in selected patients with symptomatic vasospasm refractory to conventional treatment after careful consideration of benefits and procedure-related risks.
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Raimund
R
Helbok
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Alexandra
A
Zangerle
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Andreas
A
Chemelli
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Ronny
R
Beer
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Thomas
T
Benke
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Rainer
R
Ehling
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Marlene
M
Fischer
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Martin
M
Sojer
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Bettina
B
Pfausler
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Claudius
C
Thome
Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
Erich
E
Schmutzhard
Delayed cerebral ischemia; Nimodipine; Subarachnoid hemorrhage; Vasospasm