Abstract 390: Angiographic Evidence of Vasospasm Improvement After Intraventricular Milrinone
Bibliographic record
Abstract
Background Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains a leading cause of delayed cerebral ischemia (DCI). Standard therapies are often insufficient in refractory cases. Milrinone, a phosphodiesterase‐3 inhibitor with vasodilatory and anti‐inflammatory properties, has emerged as a potential treatment via intra‐arterial, intravenous, or intrathecal routes. However, intraventricular (IVT) administration remains scarcely reported. Case Report A 70‐year‐old man with atrial fibrillation on apixaban presented with seizure and was found to have diffuse SAH (modified Fisher grade 4) from a ruptured left internal carotid aneurysm. He underwent coil embolization and placement of an external ventricular drain (EVD). Despite nimodipine, hemodynamic augmentation, and intravenous milrinone (Montreal protocol), he developed diffuse vasospasm. Digital subtraction angiography confirmed moderate‐to‐severe narrowing, and intra‐arterial verapamil produced only transient benefit. IVT milrinone (870 mcg) was then administered via the EVD. Repeat angiography at 10 and 20 minutes demonstrated progressive arterial dilation (≈40% in MCA and ACA segments) and improved perfusion. The patient remained hemodynamically stable, including an intracranial pressure below 20 mmHg. IVT dosing was continued every eight hours. Although his hospital course was later complicated by acute respiratory distress syndrome unrelated to therapy, IVT milrinone was consistently associated with angiographic improvement. Conclusion This case demonstrates rapid, real‐time angiographic reversal of refractory vasospasm with intraventricular milrinone. By delivering high local concentrations directly into cerebrospinal fluid, IVT administration may overcome the limitations of systemic or intra‐arterial therapy. It may represent a practical bedside alternative that combines local efficacy with reduced repeated angiography procedural risk exposure. Larger prospective studies are needed to establish dosing, safety, and its role in improving long‐term outcomes in SAH. image image
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".