title: The haemodynamic effect of transcranial Doppler-guided high-dose nimodipine treatment in established vasospasm after subarachnoid haemorrhage.
abstract: Eleven patients (7 females) with aneurysmal subarachnoid haemorrhage (SAH) and transcranial Doppler (TCD) signs of vasospasm during prophylactic intravenous nimodipine treatment (2 mg/h) were treated with TCD-guided high-dose (4 mg/h) intravenous nimodipine. The patients were followed clinically and with serial TCD investigations. Increasing nimodipine to high-dose treatment led to a reduction of the abnormally elevated mean flow velocities (FV) in all patients. There was also a reversal of clinical signs of delayed ischaemia. In one patient, repeated computer tomographic (CT) investigations revealed a reversal of ischaemic changes. Reduction of nimodipine from 4 to 2 mg/hr resulted in a return to abnormally elevated mean FV as well as a return of clinical signs of cerebral ischaemia. The outcome was favourable in 82% of the patients and there was no mortality or vegetative survival. No patient deteriorated clinically due to vasospasm during treatment with high-dose nimodipine. The individual effect of nimodipine treatment can be monitored by the use of serial TCD investigations. TCD-guided high-dose nimodipine treatment appears to be an effective treatment in SAH patients developing vasospasm despite prophylactic standard dose treatment. The data give support for a direct vascular effect of nimodipine on cerebral vasospasm.
authors: Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden.
authors: S C
authors: SC
authors: Zygmunt
authors: T J
authors: TJ
authors: Delgado-Zygmunt
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity / Q000187:drug effects; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial / Q000187:drug effects*