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nlm-article

Cover Journal of Neurosurgery: Case Lessons

Management of refractory bacterial meningitis–associated cerebral vasospasm: illustrative case

Sofya Norman, Jon Rosenberg, Sri Hari Sundararajan, Ali Al Balushi, Srikanth Reddy Boddu, and Judy H. Ch’ang

BACKGROUND

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.

OBSERVATIONS

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.

LESSONS

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.

Open access

nlm-article

Cover Neurosurgical Focus: Video

Flow diversion for cerebral aneurysms

Joseph A. Carnevale, Jacob L. Goldberg, Gary Kocharian, Andrew L. A. Garton, Alexander Ramos, Justin Schwarz, Srikanth Reddy Boddu, Y. Pierre Gobin, and Jared Knopman

The treatment of cerebral aneurysms includes open microsurgical options (e.g., clipping, trapping/bypass) and evolving endovascular techniques. Following the landmark trials that propelled endovascular treatment to the forefront, flow diversion has shown high aneurysm cure rates with minimal complications. Flow diversion stents are placed in the parent vessel, redirecting blood flow from the aneurysm, promoting reendothelization across the neck, and resulting in complete occlusion of the aneurysm. As a result, flow diversion has become increasingly used as the primary treatment for unruptured aneurysms; however, its applications are being pushed to new frontiers. Here, the authors present three cases showcasing the treatment of intracranial aneurysms with flow diversion.

The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2253