通过在脑膜中动脉内动脉注射利多卡因来短期治疗蛛网膜下腔出血相关头痛。
Intra-arterial lidocaine administration of lidocaine in middle meningeal artery for short-term treatment of subarachnoid hemorrhage-related headaches.
作者信息
Qureshi Adnan I, Bains Navpreet K, Bhatti Ibrahim A, Jani Vishal, Suri M Fareed K, Bhogal Pervinder
机构信息
Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
Department of Neurology, University of Missouri, Columbia, MO, USA.
出版信息
Interv Neuroradiol. 2025 Jan 17:15910199241307049. doi: 10.1177/15910199241307049.
BACKGROUND AND PURPOSE
We report short- and intermediate-term effects on headaches with intra-arterial injection of lidocaine in the middle meningeal artery in patients with severe headaches associated with subarachnoid hemorrhage.
METHODS
We treated seven patients with intra-arterial lidocaine in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). We recorded the maximum intensity of headache (graded by 11-point numeric rating scale) prior to procedure and every day for the next 10 days or discharge, whichever came first. We identified changes in the middle meningeal artery pre- and post-intra-arterial lidocaine administration and quantified from Grade 0 (no change) to Grade 5 (severe narrowing or near occlusion of anterior and posterior dural branches or proximal middle meningeal artery that precludes adequate imaging of distal branches).
RESULTS
We observed improvement in severity of headaches of headache in all seven subarachnoid hemorrhage patients. The resolution of headache was immediate and complete in four patients, unilateral immediate resolution in one patient, and delayed complete resolution in patient. Two patients met the definition of severe headache (defined as 2 or more days with maximum pain scores of 8 or greater or need for 3 or more different analgesics for 2 or more days) post-lidocaine treatment. One of these patients had are lapse in headache with the severity matching pretreatment severity and required a second treatment. On analysis of angiographic data, there was consistent narrowing of middle meningeal arteries after administration of intra-arterial lidocaine and was graded as 5 in 2 arteries, 4 in 10 arteries, and 3 in 2 arteries.
CONCLUSIONS
We found that intra-arterial injection of lidocaine can result in consistent amelioration of headache in patients with subarachnoid hemorrhage. The therapeutic benefit may be related to vasoconstriction (reversal of vasodilation) in the middle meningeal arteries after administration of lidocaine.
背景与目的
我们报告了在蛛网膜下腔出血相关严重头痛患者中，经脑膜中动脉动脉内注射利多卡因对头痛的短期和中期影响。
方法
我们通过微导管双侧（除一名患者外）在每个脑膜中动脉内给予7名患者动脉内利多卡因，剂量高达50毫克。我们记录了手术前以及接下来10天或出院（以先到者为准）每天头痛的最大强度（采用11点数字评分量表分级）。我们确定了动脉内利多卡因给药前后脑膜中动脉的变化，并从0级（无变化）到5级（硬脑膜前、后分支或脑膜中动脉近端严重狭窄或近乎闭塞，无法对远端分支进行充分成像）进行量化。
结果
我们观察到所有7例蛛网膜下腔出血患者的头痛严重程度均有改善。4例患者头痛立即完全缓解，1例患者单侧立即缓解，1例患者延迟完全缓解。两名患者在利多卡因治疗后符合严重头痛的定义（定义为2天或更长时间最大疼痛评分达到8分或更高，或2天或更长时间需要3种或更多不同的镇痛药）。其中一名患者头痛复发，严重程度与治疗前相当，需要进行第二次治疗。分析血管造影数据发现，动脉内注射利多卡因后脑膜中动脉持续狭窄，2条动脉评为5级，10条动脉评为4级，2条动脉评为3级。
结论
我们发现动脉内注射利多卡因可使蛛网膜下腔出血患者的头痛持续改善。治疗益处可能与利多卡因给药后脑膜中动脉的血管收缩（血管舒张逆转）有关。
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