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The haemodynamic effect of transcranial Doppler-guided high-dose nimodipine treatment in established vasospasm after subarachnoid haemorrhage

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Summary

Eleven patients (7 females) with aneurysmal subarachnoid haemorrhage (SAH) and transcranial Doppier (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.

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  1. Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden

    S. C. Zygmunt & T. J. Delgado-Zygmunt

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  1. S. C. Zygmunt
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  2. T. J. Delgado-Zygmunt
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Zygmunt, S.C., Delgado-Zygmunt, T.J. The haemodynamic effect of transcranial Doppler-guided high-dose nimodipine treatment in established vasospasm after subarachnoid haemorrhage. Acta neurochir 135, 179–185 (1995). https://doi.org/10.1007/BF02187765

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