Subarachnoid hemorrhage from an intracranial aneurysm during pregnancy is a rare complication but with high maternal and fetal mortality. We report a 37-year-old woman during the 25th gestational week who was under treatment of preterm labor when she suffered from subarachnoid hemorrhage due to a ruptured cerebral aneurysm. Emergent surgical clipping of the aneurysm was performed and the following severe vasospasm was successfully treated by intra-arterial infusions in combination with Fasudil Hydrochloride and Milrinone. The patient had a good outcome and delivered a healthy female by cesarean section.
Milrinone is a direct vasodilator with noncatecholamine, nonglycosidicinotropic activity. Although its potency is known to be 10-30 times higher than that of the parent compound Amrinone, fewer adverse effects like hypotension are reported.
Intra-arterial combined use of Fasudil Hydrochloride and Milrinone is an effective and safe treatment of choice in a pregnant patient with severe vasospasm after subarachnoid hemorrhage, because both maternal and fetal hypotension can be avoided.