Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Authors

Wade S. Smith, University of California, San Francisco
Christopher F. Dowd, University of California, San Francisco
S. Claiborne Johnston, University of California, San Francisco
Nerissa U. Ko, University of California, San Francisco
Stephen J. DeArmond, University of California, San Francisco
William P. Dillon, University of California, San Francisco
Deepa Setty, University of California, San Francisco
Michael T. Lawton, University of California, San FranciscoFollow
William L. Young, University of California, San Francisco
Randall T. Higashida, University of California, San Francisco
Van V. Halbach, University of California, San Francisco

Document Type

Conference Proceeding

Abstract

Background and Purpose - Papaverine is used to vasodilate cerebral arteries undergoing vasospasm from subarachnoid hemorrhage. However, papaverine inhibits cellular respiration in vitro and could cause neurotoxicity in humans. Methods - We studied 5 consecutive patients with cerebral vasospasm who were treated with intra-arterial papaverine preserved with chlorobutanol and imaged with MRI fluid-attenuated inversion recovery and diffusion-weighted imaging after treatment. One patient had histological analysis of the brain at autopsy. Results - All 5 patients exhibited marked neurological decline immediately after treatment, and this was sustained through hospital discharge. In all cases, MRI images showed selective gray matter-only signal changes within the vascular territory treated with papaverine. Histological analysis of 1 case brought to autopsy showed selective injury to islands of neurons with relative sparing of white matter. Conclusions - Intra-arterial delivery of papaverine preserved with chlorobutanol into vasospastic anterior cerebral arteries may result in marked neurological deterioration with selective gray matter changes on MRI imaging. This effect is consistent with a permanent toxic effect to human brain. It is unclear whether this toxicity is caused by papaverine or chlorobutanol, and its use in the treatment of cerebral vasospasm should be reserved for cases without alternatives.

Publication Date

11-1-2004

Publication Title

Stroke

ISSN

00392499

Volume

35

Issue

11

First Page

2518

Last Page

2522

PubMed ID

15472097

Digital Object Identifier (DOI)

10.1161/01.STR.0000144682.00822.83

Recommended Citation

Smith, Wade S.; Dowd, Christopher F.; Johnston, S. Claiborne; Ko, Nerissa U.; DeArmond, Stephen J.; Dillon, William P.; Setty, Deepa; Lawton, Michael T.; Young, William L.; Higashida, Randall T.; and Halbach, Van V., "Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage" (2004). Neurosurgery. 890.
https://scholar.barrowneuro.org/neurosurgery/890