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The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage.

Lasry O, Marcoux J - Springerplus (2014)

Bottom Line: Unfortunately, there is limited literature on an effective treatment of this entity.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, McGill University Health Centre, 1650 Cedar Ave., room L7-516, H3G 1A4 Montreal, QC Canada.

ABSTRACT

Introduction: 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.

Case descriptions: 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".

Discussion and evaluation: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

DSA confirming vasospasm in the narrowed M1 and M2 segments (indicated by the arrow) of the left middle cerebral artery.
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Fig3: DSA confirming vasospasm in the narrowed M1 and M2 segments (indicated by the arrow) of the left middle cerebral artery.

Mentions: On arrival, his Glasgow Coma Score (GCS) (Teasdale and Jennett 1974) was 14 with disorientation to time and place. The rest of his neurological exam was non-localizing and his hemodynamic status was stable. His initial computed tomography (CT) of the head revealed a thick collection of subarachnoid hemorrhage localized to the left sylvian fissure (Figure 1). During the first 3 days of admission his neurological status had normalized. Eight days after the trauma, the patient’s wife noted that his neurological status had changed. She therefore brought him back to the emergency room where he was found to have a right-sided hemiparesis, a right lower facial droop, dysarthria and global aphasia. He was immediately admitted to the Intensive Care Unit (ICU) for neuro-monitoring. A magnetic resonance imaging of the brain revealed restricted diffusion in the left MCA territory consistent with a subacute infarct (Figure 2). Thereafter, the Milrinone protocol was started and within 90 minutes, the patient’s symptoms had improved. The patient had a formal (Digital Subtraction Angiography) DSA that confirmed vasospasm of the M1 and M2 segments of the left middle cerebral artery (MCA) (Figure 3). The protocol was continued for a total of 9 days and the weaning of Milrinone started on the 5th day. The patient was discharged from hospital with a slight expressive aphasia and right hemiparesis, which was improved from his initial presentation.Figure 1


The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage.

Lasry O, Marcoux J - Springerplus (2014)

DSA confirming vasospasm in the narrowed M1 and M2 segments (indicated by the arrow) of the left middle cerebral artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216821&req=5

Fig3: DSA confirming vasospasm in the narrowed M1 and M2 segments (indicated by the arrow) of the left middle cerebral artery.
Mentions: On arrival, his Glasgow Coma Score (GCS) (Teasdale and Jennett 1974) was 14 with disorientation to time and place. The rest of his neurological exam was non-localizing and his hemodynamic status was stable. His initial computed tomography (CT) of the head revealed a thick collection of subarachnoid hemorrhage localized to the left sylvian fissure (Figure 1). During the first 3 days of admission his neurological status had normalized. Eight days after the trauma, the patient’s wife noted that his neurological status had changed. She therefore brought him back to the emergency room where he was found to have a right-sided hemiparesis, a right lower facial droop, dysarthria and global aphasia. He was immediately admitted to the Intensive Care Unit (ICU) for neuro-monitoring. A magnetic resonance imaging of the brain revealed restricted diffusion in the left MCA territory consistent with a subacute infarct (Figure 2). Thereafter, the Milrinone protocol was started and within 90 minutes, the patient’s symptoms had improved. The patient had a formal (Digital Subtraction Angiography) DSA that confirmed vasospasm of the M1 and M2 segments of the left middle cerebral artery (MCA) (Figure 3). The protocol was continued for a total of 9 days and the weaning of Milrinone started on the 5th day. The patient was discharged from hospital with a slight expressive aphasia and right hemiparesis, which was improved from his initial presentation.Figure 1

Bottom Line: Unfortunately, there is limited literature on an effective treatment of this entity.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, McGill University Health Centre, 1650 Cedar Ave., room L7-516, H3G 1A4 Montreal, QC Canada.

ABSTRACT

Introduction: 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.

Case descriptions: 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".

Discussion and evaluation: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus