Effects of Nimodipine Treatment on Aneurysmal Subarachnoid Hemorrhage.

Lee, Seung Yoon; Choi, Chang Hwa

Original Article

Journal of Korean Neurosurgical Society 1997;26(4): 555-562.

Department of Neurosurgery, School of Medicine, Pusan National University, Pusan, Korea.

ABSTRACT

Nimodipine, a potent, central active, calcium channel blocker, is known to relieve vasospasm, increase cerebral blood flow(CBF) and affect positively on clinical outcome in patients with subarachnoid hemorrhage. Experimentally, the potent effects on both vascular dilatation and increasing CBF were proven. However, there are still controversies and many debates at present about the actual clinical effects of nimodipine on subarachnoid hemorrhage. To evaluate the clinical effectiveness of nimodipine on aneurysmal subarachnoid hemorrhage in our series, we analyzed 122 consecutive patients with ruptured aneurysms who underwent operations between October, 1993 and June, 1995. These patients were grouped as follow: Group I consisted of 63 cases(52%) in which the patients were treated with nimodipine and Group II consisted of 59 cases(48%) in which the patients were treated conventionally. Administration of nimodipine was started immediately after the radiological diagnosis of ruptured aneurysm. The dose of nimodipine was 0.5microg/kg/min via continuous intravenous infusion for 7 to 10 days after the subarachnoid hemorrhage. After a course of intravenous treatment, oral administration of nimodipine was then continued for up to 21 days after subarachnoid hemorrhage in a dose of 60mg every four hours. We analyzed two groups based on patient's age, sex, aneurysmal location and size, timing of surgery, presence of hypertension, Hunt-Hess grade, presence of vasospasm on preoperative angiography and Fisher's CT classification. We also analyzed the incidence of delayed ischemic deficits(DID) and outcome(GOS) in each group. There were no significant differences in any of these parameters between nimodipine-treated group and the control group(p>0.05) and also, no significant differences in the distribution of DID or outcome between two groups (p>0.05). Based on these results, we conclude that nimodipine does not provide any significant beneficial effects on the prevention of DID and outcome in the patients with aneurysmal subarachnoid hemorrhage.

Key Words: Aneurysmal subarchnoid hemorrhage; Nimodipine; Vasospasm; Delayed ischemic deficit(DID); Outcome