Background. Treatment of symptomatic delayed
cerebral ischemia (DCI) after
subarachnoid hemorrhage (SAH) is difficult. Recent studies suggest intravenous (IV) high dose
milrinone as a potential
therapy. The timing to angiographic response with this is unclear. Methods. We reviewed the chart of one patient admitted for SAH who developed symptomatic DCI and was treated with high dose IV
milrinone. Results. A 66-year-old female was admitted with a Hunt and Hess clinical grade 4, World Federation of Neurological Surgeons (WFNS) clinical grade 4, and SAH secondary to a left anterior choroidal artery
aneurysm which was clipped. After bleed day 6, the patient developed symptomatic DCI. We planned for angioplasty of the proximal segments. We administered high dose IV
milrinone bolus followed by continuous infusion which led to clinical improvement prior to angiography. The angiogram performed 1.5 hours after
milrinone administration displayed resolution of the CT angiogram and MRI based
cerebral vasospasm such that further intra-arterial
therapy was aborted. She completed 6 days of continuous IV
milrinone therapy, was transferred to the ward, and subsequently rehabilitated. Conclusions. High dose IV
milrinone therapy for symptomatic DCI after SAH can lead to rapid neurological improvement with dramatic early angiographic improvement of
cerebral vasospasm.