Norman Sofya, Rosenberg Jon, Sundararajan Sri Hari, Al Balushi Ali, Boddu Srikanth Reddy, Ch'ang Judy H
1Weill Cornell Medical College, Weill Cornell Medicine, New York, New York.
2Division of Neurocritical Care.
J Neurosurg Case Lessons. 2023 Feb 13;5(7). doi: 10.3171/CASE22418.
Cerebral vasospasm is an alarming complication of acute bacterial meningitis with potentially devastating consequences. It is essential for providers to recognize and treat it appropriately. Unfortunately, there is no well-established approach to the management of postinfectious vasospasm, which makes it especially challenging to treat these patients. More research is needed to address this gap in care.
Here, the authors describe a patient with postmeningitis vasospasm that was refractory to induced hypertension, steroids, and verapamil. He eventually responded to a combination of intravenous (IV) and intra-arterial (IA) milrinone followed by angioplasty.
To our knowledge, this is the first report of successfully using milrinone as vasodilator therapy in a patient with postbacterial meningitis-associated vasospasm. This case supports the use of this intervention. In future cases of vasospasm after bacterial meningitis, IV and IA milrinone should be trialed earlier with consideration of angioplasty.
脑血管痉挛是急性细菌性脑膜炎的一种严重并发症，可能带来毁灭性后果。医疗人员必须认识并妥善治疗该病症。遗憾的是，目前尚无成熟的方法来管理感染后血管痉挛，这使得治疗这些患者极具挑战性。需要更多研究来填补这一护理空白。
在此，作者描述了一名患有脑膜炎后血管痉挛的患者，该患者对诱导性高血压、类固醇和维拉帕米治疗无效。他最终对静脉注射（IV）和动脉内（IA）米力农联合治疗有反应，随后接受了血管成形术。
据我们所知，这是首次成功使用米力农作为血管扩张剂治疗细菌性脑膜炎相关血管痉挛患者的报告。该病例支持这种干预措施的使用。在未来细菌性脑膜炎后血管痉挛的病例中，应更早试用静脉注射和动脉内米力农，并考虑血管成形术。
