Effect of cisternal papaverine on cerebral blood flow in patients with subarachnoid hemorrhage--three case reports

Three patients presenting with subarachnoid hemorrhage due to aneurysmal rupture underwent cerebral blood flow (CBF) measurements before and after cisternal injection of papaverine hydrochloride. One patient showed prominent increases in CBF in the frontal lobe and basal ganglia after injection of papaverine, but paradoxical decreases in the parietal lobe and corona radiata. The other two patients had poor CBF response. Dense clotting in the basal cisterns may have prevented diffusion of the agent so that only the proximal trunks of the internal carotid, anterior cerebral, and middle cerebral arteries were dilated in the former case. The dilation of proximal trunks of cerebral arteries might steal blood flow from the parietal lobe and corona radiata, where the intraparenchymal arteries were maximally dilated and cerebrovascular reserve capacity was poor.