Long-term effects of nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery

• Published in: Journal of neurosurgery Vol. 74; no. 1; p. 8
• Main Authors: Ohman, J, Servo, A, Heiskanen, O
• Format: Journal Article
• Language: English
• Published: United States 01.01.1991
• Subjects: Adolescent; Adult; Aged; Cause of Death; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - drug therapy; Cerebral Infarction - etiology; Double-Blind Method; Female; Humans; Infusions, Intravenous; Intracranial Aneurysm - complications; Intracranial Aneurysm - surgery; Male; Middle Aged; Nimodipine - administration & dosage; Nimodipine - therapeutic use; Prognosis; Prospective Studies; Rupture, Spontaneous; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - surgery; Tomography, X-Ray Computed
• ISSN: 0022-3085
• DOI: 10.3171/jns.1991.74.1.0008

A total of 213 patients with verified aneurysmal subarachnoid hemorrhage (SAH) of Grades I to III (Hunt and Hess classification) were enrolled in a double-blind placebo-controlled trial to determine the effect of intravenous nimodipine on delayed ischemic deterioration and computerized tomography (CT)-visualized infarcts after SAH and surgery. The administration of the drug or matching placebo was started immediately after the radiological diagnosis of a ruptured aneurysm had been made. Of the 213 patients enrolled in the study, 58 were operated on early (within 72 hours after the bleed: Days 0 to 3), 69 were operated on subacutely (between Days 4 and 7), and 74 had late surgery (on Day 8 or later). Eleven patients died before surgery was undertaken and one was not operated on. A follow-up examination with CT scanning, performed 1 to 3 years after the SAH (mean 1.4 years), revealed no significant differences in the overall outcome between the groups. However, nimodipine treatment was associated with a significantly lower incidence of deaths caused by delayed cerebral ischemia (p = 0.01) and significantly lower occurrence of cerebral infarcts visualized by CT scanning in the whole population (p = 0.05), especially in patients without an associated intracerebral hemorrhage on admission CT scan (p = 0.03).