Hemorrhage: Influence on Clinical Course and Cerebral Perfusion

BACKGROUND AND PURPOSE: The efficacy of intra-arterial administration of nimodipine (IAN) in pa-tients with severe vasospasm after aneurysmal subarachnoid hemorrhage (SAH) remains unproved. The goal of the present study was to investigate the clinical effect and cerebral perfusion after IAN in patients with severe vasospasm refractory to hemodynamic treatment. MATERIALS AND METHODS: Twenty-six of 214 patients with aneurysmal SAH were included in the prospective study, approved by the local ethics committee. All patients met the criteria of medically refractory cerebral vasospasm. Effectiveness was monitored angiographically by digital subtraction angiography and by transcranial Doppler (TCD), perfusion CT (PCT), and neurologic examination during treatment course and follow-up. RESULTS: No angiographic effect was observed in 8 patients. The pooled PCT values revealed a reduction of time to peak (P .03) and mean transit time (P .17) 1 day after intervention. This effect did not persist during the following days. The pooled TCD analysis demonstrated a transient increase in flow 1 day after intervention (P .03). No trend was evident during the next 7 days after intervention. Additional infarction was experienced by 61.1 % of patients. CONCLUSIONS: IAN in a selective patient group resulted in a positive response with reduction o