engleski

Use of nimodipine for cerebral vasospasm in patients with subarachnoidal hemorrhage

Subarachnoid hemorrhage is an emergency state that most commonly occurs following rupture of a saccular aneurysm in younger population. A number of studies have shown that about 85% of saccular aneurysms come from the frontal part of the circle of Willis, usually in the proximal segment of the anterior cerebral artery and anterior communicating artery, however, they can also occur at bifurcation of the middle cerebral artery or in the proximal segment of the anterior communicating artery and internal carotid artery. The remaining 15% of aneury sms are located in the posterior part of the circle of Willis. Subarachnoid hemorrhage should be diagnosed as early as possible, certainly before the cerebral vasospasm occurs. Some studies have indicated it appropriate to use nimodipine, a calcium channel antagonist, to prevent or reduce the possible vasospasm. In this study, we investigated the correlation between computed tomography (CT) scan and cerebral angiography in patients with clinical signs and symptoms of subarachnoid hemorrhage. The patients were trom admission daily monitored by transcranial Doppler (TCD) during the administration of nimodipine. In this retrospective study including patients admitted to the Department during the last 12 months with clinical symptoms of subarachnoid hemorrhage, CT confirmed the preliminary diagnosis in 83% of patients. Cerebral angiography showed aneurysms in 64% of the patients with positive CT scan. However, in a majority of patients (n=10) in whom angiography failed to show aneurysm, TCD indicated cerebral vasospasm, so angiography may have been "false" negative in these patients. We think that daily TCD monitoring for the presence of cerebral vasospasm is necessary from the onset of the disease, and that these patients should be treated with calcium channel antagonists as vasodilators. In this way it is possible to prevent or reduce cerebral vasospasm and indicate appropriate timing for angiography.

cerebral vasospasm

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