• Raimund Helbok, Alexandra Zangerle, Andreas Chemelli, Ronny Beer, Thomas Benke, Rainer Ehling, Marlene Fischer, Martin Sojer, Bettina Pfausler, Claudius Thome, and Erich Schmutzhard.
• Department of Neurology, Neurological Intensive Care Unit, Medical University of Innsbruck , Anichstrasse 35, 6020 Innsbruck, Austria.
• Springerplus. 2016 Jan 1; 5 (1): 1807.

IntroductionVasospasm still is a major cause of morbidity after aneurysmal subarachnoid hemorrhage. The purpose of this report is to describe the successful management of severe refractory vasospasm with continuous intra-arterial nimodipine (IAN) treatment.Case DescriptionA 72-year old right handed woman was admitted with non-traumatic SAH WFNS grade 1. Cerebral computed tomography demonstrated thick blood filling of the basal cisterns, and intraventricular hemorrhage. Cerebral angiogram failed to detect a vascular abnormality. After an uneventful initial course the patient developed symptomatic left middle cerebral artery vasospasm with aphasia and corresponding restriction in diffusion weighted images in the left frontal lobe. Bolus IAN only transiently improved cerebral circulation and clinical signs and symptoms. Continuous-IAN was started and led to full clinical recovery and normalisation of MRI diffusion restrictions.Discussion And ConclusionsContinuous selective intra-arterial infusion of nimodipine may be an option in selected patients with symptomatic vasospasm refractory to conventional treatment after careful consideration of benefits and procedure-related risks.

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