A 33 year old woman presented with severe headache, CT scan was interpreted as normal and she was discharged home after symptomatic headache treatment.  Five days later she returned with altered mentation, severe aphasia, and a national institute of health stroke scale (NIHSS) of 23.  Head CT demonstrated SAH without hydrocephalus. CTA demonstrated severe diffuse vasospasm and a small anterior communicating artery aneurysm. She underwent coiling and treatment of severe vasospasm with  balloon angioplasty and intra-arterial verapamil.  Her severe vasospasm continued and a decision was made to place a LD for intrathecal nicardipine.  Her radiographic vasospasm stabilized/improved post intrathecal nicardipine administration.  She underwent 15 intrathecal nicardipine administrations and was additionally started on intravenous milrinone in addition to standard of care for persistent severe vasospasm over 22 days in the ICU.  She was discharged with an NIHSS of 6.