Indian Journal of Critical Care Case Report

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VOLUME 2 , ISSUE 3 ( May-June, 2023 ) > List of Articles


Methylene Blue to the Rescue in Severe Vasoplegia after Oral Nimodipine in a Patient with Aneurysmal Subarachnoid Hemorrhage

Rupak Banerjee, Lawni Goswami, Debasis Rout, Suresh Ramasubban, Jayanta Sharma

Keywords : Delayed cerebral ischemia, Methylene blue, Oral nimodipine, Subarachnoid hemorrhage, Vasoplegia

Citation Information : Banerjee R, Goswami L, Rout D, Ramasubban S, Sharma J. Methylene Blue to the Rescue in Severe Vasoplegia after Oral Nimodipine in a Patient with Aneurysmal Subarachnoid Hemorrhage. 2023; 2 (3):75-77.

DOI: 10.5005/jp-journals-11006-0057

License: CC BY-NC 4.0

Published Online: 26-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim and background: We report the first case in India of refractory vasoplegia from oral nimodipine after aneurysmal subarachnoid hemorrhage (aSAH) and its successful rescue with intravenous methylene blue. Case description: A 53-year-old man presented with fever, headache, and neck pain from SAH due to the rupture of a suspected mycotic aneurysm. He was on peroral nimodipine postcoiling. After 1 hour, he developed severe hypotension, unresponsive to triple vasopressors. His low diastolic pressure pointed toward vasoplegia and after ruling out other causes with point-of-care ultrasound (POCUS), 200 mg of methylene blue was administered intravenously. The vasopressor requirement decreased immediately. No side effects were observed except chromaturia. Conclusion: Nimodipine is recommended orally to reduce unfavorable outcomes from delayed cerebral ischemia. Mild hypotension is common, but in rare cases, it may lead to profound refractory vasoplegia. This case demonstrates the successful use of methylene blue as a potential rescue therapy.

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