{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:44:38Z","timestamp":1783399478233,"version":"3.54.6"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,13]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22418","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T07:53:52Z","timestamp":1676274832000},"source":"Crossref","is-referenced-by-count":5,"title":["Management of refractory bacterial meningitis\u2013associated cerebral vasospasm: illustrative case"],"prefix":"10.3171","volume":"5","author":[{"given":"Sofya","family":"Norman","sequence":"first","affiliation":[{"name":"Weill Cornell Medical College, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri Hari","family":"Sundararajan","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Al Balushi","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikanth Reddy","family":"Boddu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/New York-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy H.","family":"Ch\u2019ang","sequence":"additional","affiliation":[{"name":"Division of Neurocritical Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Neurology","first-page":"1497","article-title":"Cerebrovascular complications of bacterial meningitis in adults","volume":"42","author":"Pfister HW","year":"1992","unstructured":"Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einh\u00e4upl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42(8):1497\u20131504.1641143"},{"issue":"6","key":"b2","series-title":"Crit Care","first-page":"R281","article-title":"Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis","volume":"15","author":"Klein M","year":"2011","unstructured":"Klein M, Koedel U, Pfefferkorn T, Zeller G, Woehrl B, Pfister HW. Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care. 2011;15(6):R281.22112693"},{"key":"b3","series-title":"Int J Inflamm","first-page":"509707","article-title":"Vasospasm in cerebral inflammation","volume":"2014","author":"Eisenhut M","year":"2014","unstructured":"Eisenhut M. Vasospasm in cerebral inflammation. Int J Inflamm. 2014;2014:509707."},{"issue":"6","key":"b4","series-title":"Arch Neurol","first-page":"575","article-title":"Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study","volume":"50","author":"Pfister HW","year":"1993","unstructured":"Pfister HW, Feiden W, Einh\u00e4upl KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol. 1993;50(6):575\u2013581.8503793"},{"issue":"3","key":"b5","series-title":"Neurocrit Care","first-page":"354","article-title":"Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol","volume":"16","author":"Lannes M","year":"2012","unstructured":"Lannes M, Teitelbaum J, del Pilar Cort\u00e9s M, Cardoso M, Angle M. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol. Neurocrit Care. 2012;16(3):354\u2013362.22528278"},{"key":"b6","series-title":"Springerplus","first-page":"633","article-title":"The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage","volume":"3","author":"Lasry O","year":"2014","unstructured":"Lasry O, Marcoux J. The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage. Springerplus. 2014;3:633.25392803"},{"issue":"3","key":"b7","series-title":"Stroke","first-page":"893","article-title":"Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage","volume":"39","author":"Fraticelli AT","year":"2008","unstructured":"Fraticelli AT, Cholley BP, Losser MR, Saint Maurice JP, Payen D. Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2008;39(3):893\u2013898.18239182"},{"issue":"3","key":"b8","series-title":"J Neurosurg","first-page":"458","article-title":"High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage","volume":"108","author":"Keuskamp J","year":"2008","unstructured":"Keuskamp J, Murali R, Chao KH. High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2008;108(3):458\u2013463.18312091"},{"issue":"4","key":"b9","series-title":"Interv Neuroradiol","first-page":"372","article-title":"Safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment after subarachnoid hemorrhage","volume":"23","author":"Chaudhry NS","year":"2017","unstructured":"Chaudhry NS, Orning JL, Shakur SF,  Safety and efficacy of balloon angioplasty of the anterior cerebral artery for vasospasm treatment after subarachnoid hemorrhage. Interv Neuroradiol. 2017;23(4):372\u2013377.28335661"},{"issue":"4","key":"b10","series-title":"Neurosurgery","first-page":"723","article-title":"Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases","volume":"48","author":"Arakawa Y","year":"2001","unstructured":"Arakawa Y, Kikuta K, Hojo M, Goto Y, Ishii A, Yamagata S. Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases. Neurosurgery. 2001;48(4):723\u2013728, discussion 728\u2013730.11322432"},{"issue":"3","key":"b11","series-title":"J Neurosurg","first-page":"971","article-title":"Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia","volume":"134","author":"Abulhasan YB","year":"2020","unstructured":"Abulhasan YB, Ortiz Jimenez J, Teitelbaum J, Simoneau G, Angle MR. Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia. 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StatPearls Publishing; September 6, 2022."},{"issue":"8","key":"b1","series-title":"Neurology","first-page":"1497","article-title":"Cerebrovascular complications of bacterial meningitis in adults","volume":"42","author":"Pfister HW","year":"1992","unstructured":"Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einh\u00e4upl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42(8):1497\u20131504.1641143"},{"issue":"6","key":"b2","series-title":"Crit Care","first-page":"R281","article-title":"Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis","volume":"15","author":"Klein M","year":"2011","unstructured":"Klein M, Koedel U, Pfefferkorn T, Zeller G, Woehrl B, Pfister HW. Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care. 2011;15(6):R281.22112693"},{"key":"b3","series-title":"Int J Inflamm","first-page":"509707","article-title":"Vasospasm in cerebral inflammation","volume":"2014","author":"Eisenhut M","year":"2014","unstructured":"Eisenhut M. Vasospasm in cerebral inflammation. Int J Inflamm. 2014;2014:509707."},{"issue":"6","key":"b4","series-title":"Arch Neurol","first-page":"575","article-title":"Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study","volume":"50","author":"Pfister HW","year":"1993","unstructured":"Pfister HW, Feiden W, Einh\u00e4upl KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol. 1993;50(6):575\u2013581.8503793"},{"issue":"3","key":"b5","series-title":"Neurocrit Care","first-page":"354","article-title":"Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol","volume":"16","author":"Lannes M","year":"2012","unstructured":"Lannes M, Teitelbaum J, del Pilar Cort\u00e9s M, Cardoso M, Angle M. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol. Neurocrit Care. 2012;16(3):354\u2013362.22528278"},{"key":"b6","series-title":"Springerplus","first-page":"633","article-title":"The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage","volume":"3","author":"Lasry O","year":"2014","unstructured":"Lasry O, Marcoux J. The use of intravenous Milrinone to treat cerebral vasospasm following traumatic subarachnoid hemorrhage. Springerplus. 2014;3:633.25392803"},{"issue":"3","key":"b7","series-title":"Stroke","first-page":"893","article-title":"Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage","volume":"39","author":"Fraticelli AT","year":"2008","unstructured":"Fraticelli AT, Cholley BP, Losser MR, Saint Maurice JP, Payen D. Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2008;39(3):893\u2013898.18239182"},{"issue":"3","key":"b8","series-title":"J Neurosurg","first-page":"458","article-title":"High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage","volume":"108","author":"Keuskamp J","year":"2008","unstructured":"Keuskamp J, Murali R, Chao KH. High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. 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Neurosurgery. 2001;48(4):723\u2013728, discussion 728\u2013730.11322432"},{"issue":"3","key":"b11","series-title":"J Neurosurg","first-page":"971","article-title":"Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia","volume":"134","author":"Abulhasan YB","year":"2020","unstructured":"Abulhasan YB, Ortiz Jimenez J, Teitelbaum J, Simoneau G, Angle MR. Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia. J Neurosurg. 2020;134(3):971\u2013982.32217799"},{"issue":"2","key":"b12","series-title":"Neurocrit Care","first-page":"165","article-title":"Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage","volume":"11","author":"Romero CM","year":"2009","unstructured":"Romero CM, Morales D, Reccius A,  Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid hemorrhage. 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