Nimodipine treatment of ischemic neurological deficits due to cerebral vasospasm after subarachnoid hemorrhage. Clinical results of a multicenter study

W. T. Koos, A. Perneczky, L. M. Auer, D. K. Böker, M. Gaab, H. Jaksche, H. Kostron, G. Meinig, Jan Paul Muizelaar, A. J. van der Werf

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11 Scopus citations

Abstract

Intravenous nimodipine was administerted to 109 patients (65 female and 44 male) with either pre- or post-operative progressive neurological deterioration from cerebral vasospasm following subarachnoid hemorrhage from a ruptured aneurysm. In 91 of the patients the efficacy of nimodipine in relieving ischemic symptoms was assessed and in all of the 109 patients the tolerance was evaluated. The aneurysms were related to following arteries: anterior communicating artery (41%), middle cerebral artery (24%), internal carotid artery (10%), vertebro-basilar arteries (4%) and others (5.5%); 11% of the patients had multiple aneurysms. On 16 of the 91 patients no surgery was performed. On 16% of the remaining 75 patients surgery was performed within 72 hours after the hemorrhage, 57% were operated between day 4 and day 15 and 29% after day 16. The ischemic neurological deficits occurred preoperatively in 67% of the patients and post-operatively in 23%. At the beginning of treatment 84% of the patients were graded III-V according to the Hunt and Hess grading system. Most of the patients received doses of 24-48 mg nimodipine daily as constant i.v. infusion for 7-10 days. The grade of neurological deficit at the end of the treatment was evaluated according to the Glasgow Outcome Scale. 59 (65%) of the patients showed complete recovery or marked improvement of the ischemic symptoms while 22% remained unchanged and 11% died due to severe vasospasm. Administration of nimodipine seemed to be more efficient in cases where treatment was started within 24 hours. In the patient group which was treated pre-operatively, recurrent hemorrhage was recorded in 8% of the patients. Changes in heart rate and hypotension were side-effects that can also be observed during the spontaneous course of the disorder. The organic solvent of the parenteral formulation may cause reversible increases of liver enzymes. Interactions with the numerous, simultaneously administered drugs (steroids, anticonvulsants, sedative, analgesics, antihypertensives, antifibrinolytics etc.) was not noticeable. The results of this study support the view that nimodipine proved to be of considerable value in the treatment of ischemic complications connected with ruptured intracranial aneurysms.

Original languageEnglish (US)
Pages (from-to)114-117
Number of pages4
JournalNeurochirurgia
Volume28
Issue numberSUPPL. 1
StatePublished - 1985
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology

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    Koos, W. T., Perneczky, A., Auer, L. M., Böker, D. K., Gaab, M., Jaksche, H., Kostron, H., Meinig, G., Muizelaar, J. P., & van der Werf, A. J. (1985). Nimodipine treatment of ischemic neurological deficits due to cerebral vasospasm after subarachnoid hemorrhage. Clinical results of a multicenter study. Neurochirurgia, 28(SUPPL. 1), 114-117.