Survey of clinical experience with nimodipine in patients with subarachnoid hemorrhage

Calcium Antagonists in the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Review

Cerebral arterial vasospasm and infarction is the leading cause of death and disability among patients who reach a major medical center after aneurysmal subarachnoid hemorrhage (SAH). Recent evidence suggests that two calcium antagonists, nimodipine or nicardipine, may be useful in preventing this important complication of SAH. This paper reviews the current status of these two calcium antagonists in the management of SAH.

Prevention of eclampsia

Eclampsia continues to be a major cause of maternal morbidity and mortality rates, especially in underdeveloped nations. Our data indicate that eclampsia may represent the end stage of at least two very different pathophysiological pathways: one in which cerebral perfusion is low because of vasospasm and another in which cerebral perfusion is increased because of abnormal autoregulation and a failure of the normal protective mechanisms. Magnesium sulfate has been extensively used in the management and prevention of eclamptic seizures in the United States and has been recently shown to be superior to both diphenylhydantoin and diazepam. We have shown that magnesium sulfate is a potent vasorelaxant and that its action may depend on improving cerebral perfusion. Nimodipine, a calcium channel blocker with selective cerebrovascular effect, is currently under investigation in severe preeclampsia. The data show that it is as effective as magnesium sulfate in preventing eclampsia, with less maternal and fetal side effects. Magnesium sulfate and nimodipine have opposite effects on the estimated cerebral perfusion pressure as determined with the Doppler ultrasound. We speculate that the estimated cerebral perfusion pressure may be used to determine the type of cerebrovascular abnormality and the most appropriate treatment in each individual patient with preeclampsia.

Nimodipine in the prevention of ischaemic deficits after aneurysmal subarachnoid haemorrhage. An analysis of recent clinical studies

An analysis of the recent trials on the effect of nimodipine on the prevention of delayed ischaemic deficits (DID) due to vasospasm provides strong evidence that the drug reduces the incidence and the severity of DID. Placebo-controlled prospective randomized studies with oral administration of nimodipine prove that patients treated with nimodipine suffer severe disability or death due to vasospasm less frequently than those not treated. Non-controlled open prospective trials with early surgery and intravenous and oral nimodipine present the lowest published incidence of DID in aneurysmal subarachnoid haemorrhage.