Intravenous Nimodipine in Initial Intensive Care Management of Vasospasm in Aneurysmal Subarachnoid Haemorrhage – A Review

Abstract

Background: As known to every Neuroscientist the spontaneous subarachnoid haemorrhage is a medical condition in which bleeding occurs in subarachnoid space due to cerebrovascular disease most commonly due ruptured aneurysms. Nimodipine is a calcium channel antagonist used to treat vasospasm. When compared to oral, intravenous nimodipine shows better neurological outcome with low dose, less frequency of administration and less fluctuations of blood pressure in between doses ( as in oral ) due to availability of continuous infusion . Titrated dose Intra venous nimodipine is useful in the initial Intensive Care management of Subarachnoid haemorrhage for Vasospasm with close monitoring of blood pressure.Objective: To evaluate the clinical outcomes of intravenous Nimodipine in the management of acute ischemic vasospasm in subarachnoid hemorrhagic patients. Material and methods: The study was a prospective and observational study conducted in all inpatients with SAH having acute ischemic vasospasm in the intensive care unit using IV Nimodipine admitted the department of Neurosurgery in AIMS during a period of 1yr.Results: Evaluation of SAH occurrence in study patients (n=38) showed predominance of females (68.4%) and majority with hypertension (57.9%) as the common comorbid condition. The chance of developing SAH was high in patients who did not practice any form of exercise (60.5%). None of the patients had occurrence of adverse drug reactions while administering IV nimodipine other than hypotension which was corrected with inotropic support with close blood pressure monitoring. Out of the subjects enrolled, 37 patients showed improvement clinically and resolution of ischemic changes in CT scan . Majority of patients experienced cerebral edema. Using pair t test, it was found that the difference between the Glasgow Coma Score pre and follow up post treatment score were mild. Using pair t test, it was found that the difference between the mRS pre and follow up post treatment score were significant.Conclusion: Introduction of IV Nimodipine to the treatment strategy of SAH showed significant improvement in the clinical and radiological outcome.IV Nimodipine showed benefit in treating the condition without any life-threatening adverse events other than correctable hypotension. A significant decrease in the mRS score in majority of patients after treatment indicates the improvement in the quality of life of SAH patients. Pre and Post neurological status strengthens the evidence of improvement in our study subjects.