Continuous intra-arterial infusion of verapamil for treatment of severe vasospasm after subarachnoid hemorrhage

We present a patient with SAH and refractory vasospasm. After coil embolization of the aneurysm and initial near complete improvement, the patient developed severe DCI causing coma. Medical therapy failed and angiography showed severe vasospasm complicated by chronic occlusion of distal left ICA. Balloon angioplasty of proximal right ICA was attempted but failed, as a micro wire could not be advanced into the distal ICA and proximal ACA, MCA, and basilar arteries. Intra-arterial verapamil injection produced transient improvement but angioplasty could not be performed. Due to severe bilateral cerebral hypoperfusion, continuous intra-arterial verapamil was infused using micro-catheters placed in the right ICA and vertebral artery. After 22 h there was significant improvement in caliber of both vessels and perfusion in both hemispheres without complications.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research

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Aneurysmal subarachnoid hemorrhage (aSAH) is responsible for 5% to 10% of all strokes in the United States annually and is a neurologic emergency with considerable morbidity and mortality. A common complication of aSAH is cerebral vasospasm (CVS) or narrowing of the cerebral arteries. While nearly 70% of aSAH patients will develop CVS, approximately 30% of those patients will go on to develop delayed cerebral ischemia, defined as symptomatic vasospasm or cerebral infarction demonstrated on imaging. While the pathophysiology of CVS is unclear, the prevention and treatment of this complication are a focus of ongoing research...
Source: Critical Care Nursing Quarterly - Category: Nursing Tags: Original Articles Source Type: research
We present a technical report of a patient with extensive subarachnoid hemorrhage from a ruptured distal PICA aneurysm. The patient was taken to the hybrid OR with biplane fluoroscopy, utilizing a unique operative set-up to enable safe endovascular treatment. The PICA aneurysm was treated via a transradial approach with distal PICA occlusion using Onyx liquid embolysate. The patient remained neurologically intact and was discharged home after 14 days. This case illustrates a number of technical adjustments that may be made in the safe treatment of patients in whom obesity otherwise limits treatment options.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
Background: In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), microsurgical clipping, and endovascular therapy (EVT) with coiling are modalities for securing the ruptured aneurysm. Little data is available regarding associated readmission rates. We sought to determine whether readmission rates differed according to treatment modality for ruptured intracranial aneurysms. Methods: The Nationwide Readmissions Database (NRD) was used to identify adults who experienced aSAH and underwent clipping or EVT.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
ConclusionThe specificity of large aneurysm for predicting rebleeding after SAH is relatively high. However, its overall accuracy for predicting aneurysm rebleeding is not very satisfying. A comprehensive model should be developed to improve the accuracy of rebleeding prediction after SAH.
Source: Neurological Sciences - Category: Neurology Source Type: research
AbstractTranslational genomics represents a broad field of study that combines genome and transcriptome-wide studies in humans and model systems to refine our understanding of human biology and ultimately identify new ways to treat and prevent disease. The approaches to translational genomics can be broadly grouped into two methodologies, forward and reverse genomic translation. Traditional (forward) genomic translation begins with model systems and aims at using unbiased genetic associations in these models to derive insight into biological mechanisms that may also be relevant in human disease. Reverse genomic translation...
Source: Neurotherapeutics - Category: Neurology Source Type: research
Semin Neurol DOI: 10.1055/s-0040-1702942Reversible cerebral vasoconstriction syndrome (RCVS) is a clinical–radiologic diagnosis that affects children and adolescents, but it is much more frequently reported in adults. Clinically, patients present with severe and commonly recurrent thunderclap headaches. Typical precipitating triggers include vasoactive substances, serotonergic agents, and the postpartum period. There may be associated neurologic complications at presentation or in the weeks following, such as convexity subarachnoid hemorrhage, stroke, cerebral edema, cervical artery dissection (CeAD), and seizures. A...
Source: Seminars in Neurology - Category: Neurology Authors: Tags: Review Article Source Type: research
Adipocyte fatty acid –binding protein (FABP4) is an adipokine that plays an important role in development of cardiovascular and metabolic diseases. The aim of this study was to assess the 3-month prognostic val...
Source: Journal of Neuroinflammation - Category: Neurology Authors: Tags: Research Source Type: research
AbstractBackgroundRecurrent bleeding from an intracranial aneurysm after subarachnoid hemorrhage (SAH) is associated with unfavorable outcome. Recurrent bleeding before aneurysm occlusion can be performed occurs in up to one in five patients and most often happens within the first 6 h after the primary hemorrhage. Reducing the rate of recurrent bleeding could be a major factor in improving clinical outcome after SAH. Tranexamic acid (TXA) reduces the risk of recurrent bleeding but has thus far not been shown to improve functional outcome, probably because of a higher risk of delayed cerebral ischemia (DCI). To reduce the r...
Source: Trials - Category: Research Source Type: clinical trials
Magnetic resonance imaging (MRI) has revolutionized medicine, but MRI scanners are so demanding that access to them is still a challenge. MRI machines typically require specially built rooms with magnet quench vent pipes, entry systems that check peo...
Source: Medgadget - Category: Medical Devices Authors: Tags: Emergency Medicine Neurology Neurosurgery Radiology Source Type: blogs
Although qualitative or semiquantitative clinical grades (such as WFNS grade and modified Fisher grade) are well known to be associated with DCI following aSAH, identification of an easily measurable and more objective biomarker for predicting DCI might be helpful for early prediction and risk mitigation. In the current study, we found that the early stage neuroglobin level was a significant predictor of DCI in aSAH patients. Furthermore, combined use of WFNS grade and Ngb level might be able to better identify aSAH patients with high risk of DCI. AbstractBackgroundThe neuroglobin (Ngb) is well recognized as a potential bi...
Source: Brain and Behavior - Category: Neurology Authors: Tags: ORIGINAL RESEARCH Source Type: research
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