Papaverine Therapy Research Articles

Case series: Monocular visual loss associated with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms

To describe variations in the presentation of monocular visual loss associated with intracranial aneurysm rupture. The clinical course, possible etiologies and management of visual loss in three patients are described. The first patient developed Terson's syndrome (vitreal hemorrhage associated with raised intracranial pressure secondary to subarachnoid hemorrhage). Following aneursymal clipping, her postoperative management was conservative and there was no improvement in visual acuity. The second patient underwent surgical clipping of internal carotid aneursysms and sustained visual loss subsequent to surgical dissection and temporary clipping around the optic nerve and anterior choroidal artery. The vessel subsequently thrombosed. Potential contributing factors to visual loss in this case included intraoperative hypotension and anemia. This patient received anti-platelet medications, and experienced subsequent improvement in visual acuity to 6/9. A third patient underwent a right orbito-frontal keyhole craniotomy with the cranial flap retracted across the orbit. Elevated intraocular pressure secondary to external orbital compression may have compromised retinal and choroidal perfusion. This patient also developed vasospasm of both anterior cerebral arteries which resolved partially with papaverine therapy. Hypertension-hypervolemia therapy was instituted, with subsequent partial recovery of visual acuity in her right eye. Perioperative monocular visual loss associated with intracranial aneurysm repair is an infrequent occurrence, and clinical presentations may be quite variable. The primary pathophysiological mechanisms are intraocular hemorrhage and ischemia of ocular structures, including the optic nerve. Early detection, via regular fundoscopic examination and treatment aimed at decreasing intraocular pressure and augmenting ocular perfusion may improve outcomes.

Subarachnoid Hemorrhage.

All patients who present with subarachnoid hemorrhage should be admitted to the intensive care unit for close neurologic and cardiorespiratory monitoring. Neurosurgical consultation should be obtained if external ventricular drain placement, arteriography, or surgical planning are considered. Seizure prophylaxis, antihypertensive treatment for mean arterial blood pressure greater than 130 mm Hg, pain control, and bed rest are important measures for the prevention of rebleeding, which is associated with a high mortality rate. Standard deep venous thrombosis and gastrointestinal prophylaxis are recommended to prevent medical complications associated with critical illness. In patients with good-grade subarachnoid hemorrhage, early arteriography and definitive aneurysm management are recommended. The location and neck size of the aneurysm and the medical condition of the patient are factors in the decision to proceed with surgical rather than interventional aneurysm management. Postoperatively, clinical examination and transcranial Doppler ultrasonography are recommended for surveillance of vasospasm. If clinical or arteriographic evidence of vasospasm is present, hemodilution, hypertension, and hypervolemia (triple H) therapy should be instituted. If vasospasm is resistant to conservative measures, balloon angioplasty or intra-arterial papaverine therapy should also be considered.

Regional Cerebral Oxygen Saturation during Intra-arterial Papaverine Therapy for Vasospasm

Regional Cerebral Oxygen Saturation during Intra-arterial Papaverine Therapy for Vasospasm

Prostaglandin E1 Versus Phentolamine/Papaverine for the Treatment of Erectile Impotence: A Double-Blind Comparison

The use of intracavernous prostaglandin E1 was studied in 48 organically impotent men. Eight men with previous chemical priapism did not have chemically induced priapism at up to 4 times the minimum effective dose of prostaglandin E1. Of 15 men with arteriogenic impotence who had failed prior intracavernous phentolamine and papaverine therapy 10 had adequate erections with prostaglandin E1. A total of 25 men received intracavernous prostaglandin E1 and phentolamine plus papaverine in a double-blind fashion. Erections with prostaglandin E1 were equal or superior to those with phentolamine plus papaverine in each case.

Overview of types and results of vascular surgical procedures for impotence.

The pathophysiologic basis for impotence, as related to possible vascular surgical procedures, is briefly discussed. In order to better classify criteria for selection and results of surgery, various relevant terms are defined. In the authors experience, conventional procedures for venous ligation have restored potency in only about 20% of cases. An additional 60% respond when given supplemental papaverine therapy. A new surgical procedure for venous ligation, which allows access to the cavernosal veins, has produced very promising results in a small pilot series. Arterial reconstruction has been effective in about 80% of a highly selected group of patients with arteriogenic impotence.

Papaverine-induced chronic liver disease

The case history of a woman with jaundice and laboratory evidence of chronic active hepatitis and cirrhosis is reported. The patient had taken papaverine for 6 yr for cerebral arterial disease. Jaundice improved after the drug was discontinued but reappeared when papaverine therapy was reintroduced. Antinuclear antibody and smooth muscle antibody were present. Clinical manifestations disappeared and laboratory results again returned to normal upon withdrawal of papaverine. This case suggests that papaverine should be added to the list of drugs known to produce chronic active hepatitis and cirrhosis.

Brief therapeutic report: papaverine prophylaxis of complicated migraine.

SYNOPSISUse of vasoconstrictor agents for treatment of migraine associated with prolonged neurologic manifestations has been controversial because permanent sequelae, though rare, occur most commonly in these patients. A slowly released form of Papaverine, 150 mg twice a day prevented the premonitory neurologic symptoms in seven patients with complicated migraine. Four of these patients also became headache‐free and the remaining three were considerably improved. Papaverine therapy was effective in patients in whom the use of ergotamine or other potent vasoconstrictor agents might be hazardous