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Article

Intra-arterial Nimodipine Combined with Intra-arterial Milrinone for the Treatment of Cerebral Vasospasm Following Subarachnoid Hemorrhage

Jina Raj1, Vysakh Visweswaran1, Remya Reghu1, N. R. Sreehari2★★ Corresponding author

  1. 1Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
  2. 2Department of Neurosurgery, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

CORRESPONDENCE

N. R. Sreehari

Department of Neurosurgery, Division of Endovascular, Vascular, Skull Base and Spine Surgery, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi - 682 041, Kerala, India.

drsreeharinr@gmail.com

Received: 12-05-2020; Revised: 21-06-2020; Accepted: 30-07-2020.

Volume 11, Issue 2 · pp. 78–80 · PUBLISHED 21 October 2020 · DOI: 10.4103/jpp.JPP_65_20

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ABSTRACT

Cerebral vasospasm is a potentially devastating complication of subarachnoid hemorrhage (SAH) associated with substantial morbidity and mortality. Although various studies have separately examined the use of intra-arterial nimodipine and intra-arterial milrinone for the treatment of delayed cerebral vasospasm in SAH, information regarding the use of the modality combining the two treatments is scarce. This is the case of a 44-year-old female patient who developed cerebral vasospasm due to the rupture of a left internal carotid artery at the level of anterior choroidal saccular aneurysm. Patients were treated with intra-arterial nimodipine 5 mg, followed by a total milrinone dose of 18 mg into the vasospastic territories preoperatively to facilitate catheter access for coiling with controlled infusion. The angiographic spasm recovered well and aneurysm coiling was done. The patient was stable throughout the hospital course and was discharged in stable condition. Intra-arterial nimodipine along with milrinone was found to be effective in this case with severe cerebral vasospasm preoperatively which is rarely reported in the literature.

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    Raj, J., Visweswaran, V., Reghu, R., & Sreehari, N. R. (2020). Intra-arterial Nimodipine Combined with Intra-arterial Milrinone for the Treatment of Cerebral Vasospasm Following Subarachnoid Hemorrhage. Journal of Pharmacology and Pharmacotherapeutics, 11(2), 78–80. https://doi.org/10.4103/jpp.JPP_65_20