Dextromethorphan/quinidine for pseudobulbar affect associated with subarachnoid hemorrhage

Dextromethorphan/quinidine, sold under the brand name Nuedexta (R) (Avanir Pharmaceutics, CA, USA), is currently the only US FDA-approved medication for the treatment of pseudobulbar affect (PBA) in the USA. However, the clinical trials for approval of this medication only involved patients diagnosed with amyotrophic lateral sclerosis or multiple sclerosis. This case report describes a 43-year-old woman who developed PBA following an acute subarachnoid hemorrhage with a basilar artery aneurysm. After failing to respond to valproate or haloperidol, she was treated with dextromethorphan/quinidine and showed a reduction in her PBA symptoms. The patient's Center for Neurologic Study-Lability Scale score improved in 1 week and the improvement was maintained at 3 weeks.