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Intraarterial nimodipine may not prevent cerebral ischaemia due to refractory vasospasm following aneurysmal subarachnoid haemorrhage

2023; Termedia Publishing House; Volume: 19; Issue: 5 Linguagem: Inglês

10.5114/aoms/169478

1896-9151

Piotr F. Czempik, Piotr S. Liberski, Tomasz Jaworski, Ewa Uszok-Gaweł, Miłosz Zbroszczyk,

Neurosurgical Procedures and Complications

We present a case report of 38-year-old female with aneurysmal subarachnoid hemorrhage (aSAH), who underwent successful endovascular coiling of aneurysms of the right middle cerebral artery (MCA) and the anterior communicating artery (Acom) in our high-volume aSAH (> 35 cases per year) medical centre.The patient initially presented the typical signs and symptoms of SAH: severe headache, vertigo, nausea, vomiting, high arterial blood pressure (ABP) (180/100 mm Hg).There was a history of arterial hypertension, which is also a common risk factor for cerebral aneurysm formation and subsequent rupture.Following the endovascular procedure, the patient was admitted to the local intensive care unit (ICU) for close monitoring and management of neurologic status and systemic physiology.Following the percutaneous embolization, the patient was fully conscious, with logical verbal contact, oriented to the person/ time/location; pupils were narrow, equal, reactive; eyeballs pointed towards the examiner; no meningeal signs were present.The management of the patient followed the most recent neurocritical care guidelines for aSAH patients [1,2].Neurologic monitoring of the patient involved regular clinical assessment (at least every 2 h) of the neurologic status, aimed particularly at the level of consciousness, intensity of headache and vertigo, presence of nausea and vomiting, and the presence of local neurologic deficits.Neurologic status monitoring involved also diagnostic imaging: computed tomography (CT), computed tomography angiography (CTA), digital subtraction angiography (DSA), and point-of care transcranial Doppler (TCD) ultrasonography (US) with transcranial color-coded duplex (TCCD).The diagnostic imaging was used for timely detection of typical neurologic complications of aSAH such as cerebral oedema, re-bleeding, hydrocephalus, vasospasm (VS), and delayed cerebral ischemia (DCI).Systemic physiology monitoring included peripheral oxygen saturation (SpO 2 ), respiratory rate, continuous electrocardiography, invasive arterial blood pressure (IABP) monitoring, serial echocardiographic examination, serial US examination of diameter and collapsibility of inferior vena cava, temperature, glucose concentration, and acid-base and electrolyte balance.Systemic physiology management involved keeping mean arterial pressure (MAP) at ≥ 90 mm Hg (IABP transducer kept at the level of external auditory meatus), ensuring euvolaemia, normal core temperature, arterial blood glucose concentration ≤ 180 mg/dl, serum Neurology