Limits...
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

CT-Head demonstrating diffuse subarachnoid hemorrhage in bilateral basal cisterns which is mainly concentrated in the left sylvian fissure (Fisher Grade 3).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4216821&req=5

Fig4: CT-Head demonstrating diffuse subarachnoid hemorrhage in bilateral basal cisterns which is mainly concentrated in the left sylvian fissure (Fisher Grade 3).

Mentions: On arrival, her vital signs were stable and she had a GCS of 14. A CT-head was completed which revealed diffuse and thick subarachnoid hemorrhage, which was mainly centered over the left sylvian fissure and convexity (Figure 4). The patient’s GCS was 15 without any neurological deficits within 36 hours of her admission. On the 7th day post-trauma, she was found to be somnolent, expressively aphasic, dysarthric and weak on her right hemibody with a right lower facial droop. She was transferred to the ICU and had a CT-Angiography (CTA) that revealed focal narrowing of the M1 and M2 segments of the left MCA. She was therefore started on the Milrinone protocol. Her delayed ischemic deficits completely resolved within 2 hours. Weaning of the drug started 4 days after her ICU admission. She was slowly weaned off Milrinone over 6 days due to recurrence of DINDs. She had no residual deficits after her discharge from the ICU.Figure 4


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

Lasry O, Marcoux J - Springerplus (2014)

CT-Head demonstrating diffuse subarachnoid hemorrhage in bilateral basal cisterns which is mainly concentrated in the left sylvian fissure (Fisher Grade 3).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: CT-Head demonstrating diffuse subarachnoid hemorrhage in bilateral basal cisterns which is mainly concentrated in the left sylvian fissure (Fisher Grade 3).
Mentions: On arrival, her vital signs were stable and she had a GCS of 14. A CT-head was completed which revealed diffuse and thick subarachnoid hemorrhage, which was mainly centered over the left sylvian fissure and convexity (Figure 4). The patient’s GCS was 15 without any neurological deficits within 36 hours of her admission. On the 7th day post-trauma, she was found to be somnolent, expressively aphasic, dysarthric and weak on her right hemibody with a right lower facial droop. She was transferred to the ICU and had a CT-Angiography (CTA) that revealed focal narrowing of the M1 and M2 segments of the left MCA. She was therefore started on the Milrinone protocol. Her delayed ischemic deficits completely resolved within 2 hours. Weaning of the drug started 4 days after her ICU admission. She was slowly weaned off Milrinone over 6 days due to recurrence of DINDs. She had no residual deficits after her discharge from the ICU.Figure 4

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