Zolpidem-Induced Functional Recovery in a Patient with Intraventricular Hemorrhage from a Ruptured Arteriovenous Malformation: A Case Report

Case Diagnosis: A patient with an intraventricular hemorrhage (IVH) and hydrocephalus from a ruptured arteriovenous malformation (AVM) demonstrated paradoxical functional improvement after zolpidem administration.

Case Description or Program Description: A 25-year-old female with IVH and hydrocephalus from a ruptured AVM underwent craniotomy and ventriculoperitoneal shunt placement. At 8 months post-injury, she was non-verbal, primarily communicated by lifting her left fingers to answer yes/no questions, and depended on a gastrostomy tube for nutrition. On day 262 post-injury, she received a dose of zolpidem 10 mg and within 30-60 minutes, demonstrated phonation and improved head and neck control. The following morning, after a scheduled 10 mg dose, she intelligibly verbalized words for the first time since her injury. By day 264, a second 10 mg dose at noon was introduced to optimize therapy participation, followed by a 5 mg evening dose on day 293. The effects of each dose lasted approximately 4 hours.

Setting: Acute rehabilitation

Assessment/Results: 2 months after starting zolpidem, the patient demonstrated sustained functional gains in speech, swallowing, cognition, and mobility. She intelligibly verbalized short phrases, tolerated a chopped solids diet, and exhibited improved processing speed, muscle activation, and gait with assistance. These improvements persisted with continued dosing.

Discussion (relevance): We present a unique case of a patient with IVH secondary to a ruptured AVM who experienced significant functional improvements after zolpidem initiation. Similar effects have been reported in patients with brain injuries due to strokes, trauma, and hypoxia. Evidence suggests that zolpidem enhances activity in brain regions involved in motor control and consciousness in a subset of patients with chronic injuries.

Conclusions: Zolpidem may serve as a valuable adjunctive intervention in functional recovery for patients with IVH from a ruptured AVM. These findings contribute to evidence supporting zolpidem’s potential role in neurological recovery following brain injuries and underscore the need for further research across diverse patient populations.