A Case of Hyper acute Onset of Vasospasm after Aneurismal SAH and Refractory Vasospasm treated with Intravenous and Intraventricular Nitric Oxide: A mini review.
World Neurosurg. 2016 Apr 21;
Authors: Ehlert A, Manthei G, Hesselmann V, Mathias K, Bein B, Pluta R
Abstract
We report a 65-year old woman admitted within 1 hour after aneurismal SAH (Hunt&Hess III°, Fisher modified by Frontera IV°) with arteriographically confirmed hyperacute vasospasm, whose severe clinical course of vasospasm was successfully treated with NO donors. A source of SAH, the right MCA aneurysm was immediately coiled and the patient was placed on standard anti-vasospastic therapy. However, within 48 hours after aneurysm repair she developed cerebral vasospasms with clinical deterioration (delayed cerebral ischemia; DCI). Since the standard therapy failed to control clinical symptoms of DCI and to address severe vasospasm, an individualized rescue treatment with nitric oxide (NO) donors, was initiated. An intravenous continuous Molsidomine infusion had been started and clinical stabilization was achieved for a week (HH I°, WFNS I°) when vasospasm and DCI recurred, which required escalation of NO donor therapy by adding intraventricular boluses of sodium nitroprusside (SNP). Over the course of 22 days, 7 transient clinical vasospasm-related deteriorations were treated with boluses of SNP during continued Molsidomine therapy and each time vasospasm and DCI were completely reversed. Despite severe complications of aneurismal SAH that usually result in a poor outcome, the clinical outcome of this patient was excellent. At 3, 6, and 12 months follow up her mNIH-SS and mRS were 0. We present and discuss the use NO donors in cases of resistant severe vasospasm and DCI.
PMID: 27109628 [PubMed - as supplied by publisher]
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