Nimodipine in the Treatment of Subarachnoid Hemorrhage Secondary to Aneurysm Rupture: Five Years’ Experience

Abstract

The prevention of vasospasm has always been a key issue in the treatment of subarachnoid hemorrhage (SAH) secondary to aneurysmal rupture. According to the Iowa Cooperative Study [8], this complication is present in 38% of patients who have suffered an SAH. The subsequent cerebral ischemia has been reported to be clinically relevant in about 25%–30% of those cases [7,9]. In the last few years the therapeutic approach to this problem as well as the management of ruptured aneurysms in general has undergone substantial changes [1–6,11]. Some of these recent advances were included in a therapeutic protocol we have been using since March 1984. The following is a brief summary of our new therapeutic strategy:

• Intravenous and intrathecal application of nimodipine

• Early operation except for patients in grades IV and V of the Hunt and Hess classification without a relevant intra- or extra-axial hematoma, or patients harboring aneurysms of the upper vertebrobasilar circulation or with angiospasm

• Use of intraoperative “brain protection” (isoflurane and Brevimytal)

• Use of external ventricular drainage

• Induction of hypervolemia/hypertonia after aneurysm clipping and in the period thereafter

• Perioperative Doppler sonographic monitoring