2024 Volume 52 Issue 5 Pages 375-381
Clazosentan reduces cerebral vasospasm and improves outcomes in patients with subarachnoid hemorrhage. However, its effectiveness in severe cases of intracerebral hematoma is unclear. Here, we present two cases of severe subarachnoid hemorrhage with intracerebral hematoma treated with clazosentan. Case 1 is a 45-year-old woman who presented with sudden onset of consciousness disturbance and left hemiparesis. The consciousness level at admission had a Glasgow Coma Scale (GCS) score of 7. Computed tomography (CT) showed subarachnoid hemorrhage with an intracerebral hematoma in the right temporal lobe, and CT angiography revealed a right middle cerebral artery bifurcation aneurysm. Emergency surgery, including aneurysm clipping and intracerebral hematoma removal, was performed. Postoperatively, clazosentan was administered, and no cerebral vasospasms developed. The patient was discharged with a modified Rankin scale score of 1. Case 2 is an 82-year-old woman who presented with sudden onset of consciousness disturbance and left hemiparesis. The consciousness level on admission had a GCS score of 9. CT showed subarachnoid hemorrhage with an intracerebral hematoma in the right temporal lobe, and CT angiography revealed a right middle cerebral artery bifurcation aneurysm. Emergency surgery, including aneurysm clipping and intracerebral hematoma removal, was performed. Postoperative chest radiography revealed pulmonary edema. We administered clazosentan while maintaining strict fluid balance with diuretics. Mild cerebral vasospasm appeared angiographically, but was asymptomatic. The patient recovered with a modified Rankin scale score of 3. Currently, using clazosentan and emergency surgery to promptly correct intracranial pressure and prevent rebleeding may have helped improve the outcomes. Strict fluid balance management with diuretics may be required to avoid the respiratory complications associated with clazosentan administration.
