Prognostic Implication of Intra-arterial 'Verapamil-Induced' Seizure in Patients With Aneurysmal Subarachnoid Hemorrhage: A Case Report

Aneurysmal subarachnoid hemorrhage aSAH is a medical emergency resulting from rupture of a cerebral aneurysm and bleeding into the potential space between the pia mater and arachnoid membrane. Complications include acute ischemia, brain edema, hydrocephalus, and increased intracranial pressure. Late complications include rebleeding, cerebral vasospasm, and systemic complications such as cardiac and pulmonary dysfunctions. Cerebral vasospasm is a reversible and treatable cause of death after a ruptured aneurysm. Therefore, various strategies have been introduced as preventive and therapeutic options for cerebral vasospasm. One current option is intra-arterial verapamil administration, which rarely causes seizures. The prognostic implication of intra-arterial (IA) verapamil-induced seizure in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains poorly understood. We present a case of a young patient with aSAH who underwent successful endovascular management and coil embolization. The patient had complicated cerebral vasospasm and was treated with IA verapamil. During the intervention, he developed generalized tonic-clonic seizures, necessitating intubation and a prolonged stay in the intensive care unit (ICU). Notably, the patient achieved complete neurological recovery by the time of hospital discharge. This case suggests that the occurrence of seizures post-intra-arterial verapamil therapy in patients with aneurysmal subarachnoid hemorrhage is not necessarily associated with poor neurological outcome and might serve as a prognostic factor for reperfusion and, therefore, successful endovascular therapy.