Intra-arterial dantrolene for refractory cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Abstract

BACKGROUND:

Intravenous dantrolene has been used to prevent and treat cerebral vasospasm. We report a case of refractory cerebral vasospasm treated with intra-arterial dantrolene after aneurysmal subarachnoid hemorrhage.

METHODS:

A 56-year-old woman suffered a diffuse subarachnoid hemorrhage from a ruptured anterior communicating artery aneurysm which was successfully treated with coil embolization. She subsequently developed bilateral severe angiographic vasospasm which was treated with intra-arterial vasodilators. However, owing to the recurrence of vasospasm, intra-arterial dantrolene followed by balloon angioplasty was used.

RESULTS:

There was moderate improvement of the severe vasospasm in bilateral A1 segments of the anterior cerebral arteries after microcatheter-based intra-arterial infusion of 30 ml (1 mg/ml) dantrolene. Patient's hemodynamic parameters were monitored during and after the procedure and no significant changes were seen after dantrolene infusion. A follow up cerebral angiogram after 1 day demonstrated the persistence of therapeutic effect.

CONCLUSION:

Intra-arterial dantrolene induced a sustained improvement in cerebral vasospasm secondary to ruptured aneurysm. No significant side effects were observed during or after the infusion of the drug.

• Authors: Shahram Majidi, Mikayel Grigoryan, Wondwossen G Tekle, Adnan I Qureshi
• Journal: Neurocritical care (Neurocrit Care) Vol. 17 Issue 2 Pg. 245-9 (Oct 2012) ISSN: 1556-0961 [Electronic] United States
• PMID: 22815125 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Muscle Relaxants, Central
• Dantrolene

Topics

• Angioplasty, Balloon (methods)
• Anterior Cerebral Artery (diagnostic imaging)
• Cerebral Angiography
• Dantrolene (administration & dosage)
• Female
• Humans
• Infusions, Intra-Arterial
• Middle Aged
• Muscle Relaxants, Central (administration & dosage)
• Subarachnoid Hemorrhage (complications)
• Vasospasm, Intracranial (complications, drug therapy)