Intra-arterial nimodipine combined with intra-arterial milrinone for the treatment of cerebral vasospasm following subarachnoid hemorrhage

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.