Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage

Feigin, Valery L.; Rinkel, G. J. E.; Algra, A.; Vermeulen, M.; Gijn, J. van

doi:10.1212/wnl.50.4.876

Cited by 243 publications

(135 citation statements)

References 23 publications

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“…Calcium antagonists, such as nicardipine and nimodipine, reduce the proportion of vasospasm-induced ischaemic neurological deficits and nimodipine improves overall outcome within 3 months of aneurysmal SAH (18). In addition to its ability to reduce angiographically detected vasospasm, nimodpine possesses neuroprotective and anti-platelet effects which may contribute to its effectiveness.…”

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confidence: 99%

Reversible Segmental Cerebral Vasoconstriction (Call-Fleming Syndrome): the Role of Calcium Antagonists

Dodick

2003

Cephalalgia

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In 1988, Call and colleagues described four patients and reviewed a total of 19 patients from the literature who presented with a self-limited syndrome of recurrent, sudden, high-intensity headaches ('thunderclap headache') associated with nausea, vomiting, photophobia, generalized seizures (7/19), recurrent transient neurological symptoms (7/19), or permanent neurological deficits such as hemiparesis, cortical blindness (4/19) (1). Three patients became comatose and died. The common finding in all patients was the presence of diffuse segmental cerebral vasospasm involving the distal internal carotid, basilar, and major arteries of the circle of Willis which was fully reversible within weeks to months. Brain and/or cerebral blood vessel biopsies were negative in 6/19 patients and CSF examinations were mildly abnormal in five patients (three patients with elevated CSF protein 51-125), two patients with CSF lymphocytic pleocytosis (6-16 leucocytes). They felt that the segmental vasospasm was probably due to a physiological abnormality, given the lack of a structural correlate, cellular infiltrate, or hypertension in most patients.Similar clinical-angiographic patterns (sudden severe headache and diffuse vasospasm) have been described in patients with a history of migraine, as well as after carotid endarterectomy, postpartum period, Guillain-Barré syndrome, sexual intercourse, unruptured intracranial aneurysm, exertion, severe hypertension, and after administration of serotonergic, sympathomimetic medications, and illicit drugs such as cocaine (1-8).Nowak and colleagues describe the case of a 63-year-old woman who presented with multiple discrete thunderclap headaches over a 2-week period with delayed neurological deficits (cortical visual field loss and hemiparesis), diffuse segmental cerebral vasospasm, and bilateral occipital-parietal cerebral infarctions (9). Resolution of vasospasm was documented by transcranial Doppler 1 day after the intravenous administration of nimodipine and magnesium sulphate, only to recur after nimodipine was discontinued. Ultimately, headaches and vasospasm resolved 17 days after the initial symptoms. The authors conclude that calcium channel antagonists may be important therapeutic agents in the treatment of reversible cerebral vasoconstriction in patients with Call-Fleming syndrome. Their conclusion is supported by a similar case reported by Sturm and Macdonell, who described a similar clinical scenario in a 58-yearold woman who presented with recurrent severe thunderclap headaches over a 14-day period, diffuse reversible cerebral arterial vasospasm, and delayed bilateral watershed ischaemic stroke with cortical blindness (10). Vasospasm and clinical deterioration appeared to be halted by the use of intravenous nimodipine.As the literature continues to grow with case reports of this unusual disorder, the clinical spectrum is becoming more refined. As these and other cases illustrate, the clinical-angiographic syndrome of recurrent thunderclap headaches, diffuse reversible vasospasm,...

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confidence: 99%

Reversible Segmental Cerebral Vasoconstriction (Call-Fleming Syndrome): the Role of Calcium Antagonists

Dodick

2003

Cephalalgia

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“…To date, nimodipine, a member of the dihydropyridine family of calcium antagonists, has been the only medication shown to have significant improvement in clinical outcome in patients with aneurysmal SAH [37]. Typical dosing is 60mg every 4 hours orally and is continued for 21 days.…”

Section: Prophylactic Measures 3321 Nimodipinementioning

confidence: 99%

The Critical Care Management of Aneurysmal Subarachnoid Hemorrhage

Patel¹,

Samuels²

2012

Aneurysm

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“…Debido a su capacidad para relajar la célula muscular lisa vascular, se realizaron ensayos clínicos con nimodipino y nicardipino, administrados profilácti-camente por vía oral o intravenosa, para evaluar si reducían la proporción de pacientes con mal resultado neurológico y DNID tras HSA [33][34][35][36][37][38][39] . De ellos, solamente el nimodipino produjo una modesta mejoría en el resultado neurológico, por lo que es uno de los fár-macos más utilizados por vía intraarterial.…”

Section: Bloqueadores De Los Canales Del Calciounclassified

“…De ellos, solamente el nimodipino produjo una modesta mejoría en el resultado neurológico, por lo que es uno de los fár-macos más utilizados por vía intraarterial. Ambos previenen la isquemia secundaria tras HSA 34,35 .…”

Section: Bloqueadores De Los Canales Del Calciounclassified

“…Entre las estrategias terapéuticas utilizadas actualmente para la prevención del vasospasmo sintomáti-co, se encuentran la llamada triple H 5 (hipertensión, hipervolemia, hemodilución), la administración de antagonistas de los canales del calcio 6 , la cirugía precoz con retirada del coágulo subaracnoideo 7 y el drenaje de líquido cefalorraquídeo en la región lumbar 8 .…”

Section: Introductionunclassified

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Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Alcázar

González

Romance³

2008

Medicina Intensiva

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El vasospasmo cerebral es una de las principales causas de morbimortalidad en los pacientes con hemorragia subaracnoidea por rotura de un aneurisma cerebral. Cuando el vasospasmo se hace resistente al tratamiento médico máximo, el tratamiento endovascular es una opción terapéu-tica para incrementar el flujo sanguíneo cerebral y evitar lesiones isquémicas cerebrales. Los rápi-dos avances en técnicas endovasculares permiten utilizar la angioplastia transluminal percutá-nea y la infusión intraarterial de diversos fármacos vasodilatadores para revertir el vasospasmo. En este artículo se revisan las diferentes técnicas endovasculares disponibles y se describen sus mecanismos de acción, técnicas de administración, resultados clínicos y complicaciones. ENDOVASCULAR TREATMENT OF CEREBRAL VASOSPASM DUE TO ANEURYSMAL SUBARACHNOID HEMORRHAGECerebral vasospasm remains a leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to maximal medical treatment, endovascular therapies may be considered as an option to increase cerebral blood flow to prevent cerebral infarction. Endovascular techniques include transluminal balloon angioplasty and intraarterial infusion of vasorelaxants.This article reviews the various endovascular techniques for the treatment of cerebral vasospasm and discusses the mechanisms of action, techniques of administration, clinical results, and limitations of these treatment strategies.

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Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage

Cited by 243 publications

References 23 publications

Reversible Segmental Cerebral Vasoconstriction (Call-Fleming Syndrome): the Role of Calcium Antagonists

Reversible Segmental Cerebral Vasoconstriction (Call-Fleming Syndrome): the Role of Calcium Antagonists

The Critical Care Management of Aneurysmal Subarachnoid Hemorrhage

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

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