Treatment of cerebral vasospasm following severe head injury with the calcium influx blocker nimodipine.
8 patients suffering from severe head injury (Glasgow Coma Scale score of 3-5) were treated with the calcium influx blocker nimodipine (2-3 mg/h) for a traumatic cerebral vasospasm. In every case the spasm involved the frontal region of the circle of Willis with the first two segments of the anterior and middle cerebral artery. Control angiograms, recorded in 6 patients, revealed a dilated or normalized lumen of the vessels that the first angiography had revealed to be spastic. The intracranial and the mean arterial pressure were not altered by nimodipine during simultaneous neurosurgical intensive care therapy (dexamethasone, mannitol, relaxation, and controlled respiration for 2-3 days). Monitoring of the somato-sensory evoked potentials (SEP) showed a distinct improvement of the cortical response within 7 days. One patient died of sepsis 8 days after the accident and one remained in a vegetative state. The remaining patients reached Glasgow Coma Scale scores of 13.0 +/- 1.1. within 8.6 +/- 2.2 days, the initial scores having been 4.1 +/- 0.8. One year after their accident all the patients were once again fully able to work. The survival quality was therefore better than that reported in the literature for patients in similar conditions. We conclude from these preliminary results that calcium influx blockers can be used successfully in the therapy of traumatic vasospasm and of severe head injuries. A study involving a larger number of patients is currently in progress.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002533:Cerebral Angiography; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009539:Nicotinic Acids / Q000627:therapeutic use*; D009553:Nimodipine; D014665:Vasodilator Agents / Q000627:therapeutic use*
D002121:Calcium Channel Blockers; D009539:Nicotinic Acids; D014665:Vasodilator Agents; D009553:Nimodipine