Near-complete resolution of angiographic cerebral vasospasm after extreme elevation of mean arterial pressure: case report

Wilson Z Ray; Christopher J Moran; Colin P Derdeyn; Michael N Diringer; Ralph G Dacey Jr; Gregory J Zipfel

doi:10.1016/j.surneu.2008.10.006

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Near-complete resolution of angiographic cerebral vasospasm after extreme elevation of mean arterial pressure: case report

Journal article

Peer reviewed

Near-complete resolution of angiographic cerebral vasospasm after extreme elevation of mean arterial pressure: case report

Wilson Z Ray, Christopher J Moran, Colin P Derdeyn, Michael N Diringer, Ralph G Dacey Jr and Gregory J Zipfel

Surgical neurology, Vol.72(4), pp.347-353

10/2009

DOI: 10.1016/j.surneu.2008.10.006

PMID: 19147203

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Abstract

Cerebral vasospasm is a widespread and potentially treatable complication after aneurysmal SAH. Aggressive treatment often includes hemodynamic augmentation, although the exact mechanism by which such therapy leads to improved cerebral blood flow and reduced neurologic deficits is incompletely established. This case report is only the second to provide compelling evidence that hypertension can lead to direct dilation of vasospastic arteries, thereby providing valuable insight into its potential mechanism. We present a patient with SAH from a ruptured anterior communicating artery aneurysm who developed marked decline in mental status on posthemorrhage day 11, consistent with symptomatic cerebral vasospasm. A diagnostic cerebral angiogram was performed demonstrating extensive and diffuse cerebral vasospasm. After receiving a nonselective slow infusion of verapamil, the patient developed an episode of extreme hypertension. Repeat angiography immediately after hypertensive crisis revealed near-complete resolution of the previously noted cerebral vasospasm. Rapid improvement in the patient's neurologic status ensued. The present case illustrates that extreme hypertension can lead to direct dilation of vasospastic arteries and suggests that hypertensive-type hemodynamic therapy may act not only through increasing the pressure gradient across vasospastic arteries but also via direct induction of arterial vasodilation.

Cerebrovascular Circulation - physiology

Recovery of Function - drug effects

Vasodilator Agents - therapeutic use

Humans

Middle Aged

Calcium Channel Blockers - therapeutic use

Hypoxia-Ischemia, Brain - prevention & control

Cerebral Arteries - drug effects

Verapamil - therapeutic use

Hypertension - chemically induced

Recovery of Function - physiology

Female

Vasodilator Agents - pharmacology

Cerebral Arteries - diagnostic imaging

Cerebrovascular Circulation - drug effects

Vasospasm, Intracranial - diagnostic imaging

Hypoxia-Ischemia, Brain - drug therapy

Cerebral Arteries - physiopathology

Intracranial Aneurysm - complications

Subarachnoid Hemorrhage - complications

Calcium Channel Blockers - pharmacology

Verapamil - pharmacology

Hypertension - physiopathology

Cerebral Angiography

Vasospasm, Intracranial - physiopathology

Vasospasm, Intracranial - drug therapy

Hypoxia-Ischemia, Brain - physiopathology

Details

Title: Subtitle: Near-complete resolution of angiographic cerebral vasospasm after extreme elevation of mean arterial pressure: case report
Creators: Wilson Z Ray - Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. rayz@nsurg.wustl.edu
Christopher J Moran
Colin P Derdeyn
Michael N Diringer
Ralph G Dacey Jr
Gregory J Zipfel
Resource Type: Journal article
Publication Details: Surgical neurology, Vol.72(4), pp.347-353
DOI: 10.1016/j.surneu.2008.10.006
PMID: 19147203
NLM abbreviation: Surg Neurol
ISSN: 0090-3019
eISSN: 1879-3339
Publisher: Elsevier Inc; United States
Language: English
Date published: 10/2009
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984013921102771

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