Use of levosimendan in the treatment of cerebral vascular vasospasm: a case study

• Published in: Drug design, development and therapy development and therapy, 2018-01, Vol.12, p.1777-1783
• Main Authors: Onichimowski, Dariusz, Nosek, Krzysztof, Goraj, Radosław, Jalali, Rakesh, Wińska, Aleksandra, Pawlos, Aleksandra, Tuyakov, Bułat
• Format: Article
• Language: English
• Subjects: Aneurysm; Aneurysms; Arteries; Brain; Calcium; Calcium-binding protein; Cardiomyopathy; Cardiovascular system; Care and treatment; Case Report; Case reports; Case studies; Cerebral Angiography - methods; cerebral arterial aneurysm; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - drug effects; Cerebral Arteries - physiopathology; Cerebral ischemia; cerebral vasospasm; Computed Tomography Angiography; Contraction; Edema; Female; Free radicals; Health aspects; Heart failure; Hemorrhage; Humans; Hydrazones - adverse effects; Hydrazones - therapeutic use; Intensive care; Ischemia; levosimendan; Medicine; Middle Aged; Mortality; Muscles; Myocardial diseases; Neurological complications; Neurological diseases; Potassium; Potassium channels; Prognosis; Pyridazines - adverse effects; Pyridazines - therapeutic use; Simendan; Stretching; Stroke; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - drug therapy; Subarachnoid Hemorrhage - physiopathology; Tranexamic acid; Transient ischemic attack; Treatment Outcome; Troponin; Troponin C; Vasoconstriction; Vasoconstriction - drug effects; Vasodilator Agents - adverse effects; Vasodilator Agents - therapeutic use; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - drug therapy; Vasospasm, Intracranial - physiopathology; Veins & arteries
• ISSN: 1177-8881; 1177-8881
• DOI: 10.2147/DDDT.S158237

Despite the progress in the management of cerebral arterial aneurysms, subarachnoid hemorrhage (SAH) remains the major cause of neurological disability. While SAH-related deaths usually occur as a result of brain impairment due to hemorrhage, permanent neurological deficits are caused by cerebral ischemia due to edema and spasm of cerebral arteries. Additionally, ~20%-30% of patients with SAH develop secondary cardiomyopathy; this phenomenon is known as neurogenic stress cardiomyopathy (NSC), which is associated with increased mortality and poor long-term prognosis. Levosimendan is a new inotropic drug that causes calcium sensitization of troponin C, thus increasing contraction force of myofilaments. The drug also causes opening of ATP-dependent potassium channels in vascular smooth muscles, which results in dilatation of veins and arteries, including cerebral arteries. To date, there have been several reports of levosimendan application in patients with SAH and neurogenic stress cardiomyopathy, and the effect of the drug on vasospasm has been previously advocated. This paper presents a case report of a 57-year-old patient with massive SAH, where levosimendan was used for reducing vasospasm.