Long-term effects of nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery.
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).
Ohman
J
J
Department of Neurosurgery, Helsinki University Central Hospital, Finland.
Servo
A
A
Heiskanen
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D009553:Nimodipine