Resistant Vasospasm in Subarachnoid Hemorrhage Treated with Continuous Intraarterial Nimodipine Infusion

Abstract

Cerebral vasospasm complicating aneurysmal subarachnoid hemorrhage is a well-known medical entity. The delayed ischemic neurological deficits (DIND) as a result of vasospasm remain the main cause of morbidity among patients who manage to survive this severe disease pattern. When the traditional treatment options, either medical or interventional, fail to reverse vasospasm, continuous intraarterial infusion of nimodipine through catheters directly into the spastic arteries presents a promising treatment modality. Of 73 patients with aneurysmal subarachnoid hemorrhage between 2008 and 2009, a total of 27 had Hunt and Hess grades of 4 and 5. Fifteen percent of them showed refractory vasospasms and were treated with continuous nimodipine infusion via catheters in both internal carotid arteries. We present the method's indications and possible complications.

Intravenous recording of intracranial, broadband EEG

“…In the case of superior sagittal sinus thrombosis, chronic catheters left in place for several days for continuous administration of a thrombolytic agent pose little risk of venous thrombosis, if appropriate prophylactic heparinization is used (<1%) (Phillips et al, 1999). Likewise, chronic placement of arterial intravascular catheters has been used for continuous infusion of nimodipine for the treatment of vasospasm following subarachnoid hemorrhage also pose little risk of thromboembolism, if appropriate prophylactic heparinization is employed (1%) (Doukas et al, 2011). Chronic implantation of intravenous electrodes in animal models of neuropathology could reduce infection risks associated with chronic electrode implants, reduce parenchymal tissue damage associated with depth electrodes, and provide a novel perspective, particularly for vasculature-associated neuropathologies.…”

Effect of nimodipine on rat spinal cord injury

“…Biological markers of lipid peroxidation include MDA (malondialdehyde), a major end-product of polyunsaturated fatty acid peroxidation found in cell membranes (Ouardouz et al, 2009). The early inflammatory response involves extensive accumulation of inflammatory cells and cytokines and the secretion of large amounts of toxic free radicals, thereby increasing the extent of spinal cord injury; however, secretion of protective cytokines and growth factors, which mediate neuroprotection and promote nerve regeneration, also occurs in response to spinal cord injury (Hawryluk et al, 2008;Doukas et al, 2011;Lockman et al, 2012).…”

“…Nimodipine is a dihydropyridine calcium antagonist, which acts to selectively enhance brain blood flow without affecting cerebral metabolism, and which is widely used in pharmaceutical research and clinical treatment for spinal cord injury (Tan et al, 2005;Doukas et al, 2011;Han et al, 2011). In this study, adult Sprague-Dawley rats were used in a model of moderate impact spinal cord injury and the effects of early treatment with nimodipine on inflammatory responses at the site of injury were evaluated.…”

The results of Selective Intraarterial Papaverine Treatment Effect on Subarachnoidal Hemorrhage related Vasospasm

“…Günümüzde papaverin kullanımı daha yeni vazodilatörlere oranla daha kısıtlı şekilde olmaktadır. Bunlar haricinde silastazol ve sildenafil, hayvan deneylerinde oldukça fazla kullanılan iyileşmeyi hızlandırıcı ajanlardır (9)(10)(11)(12) .…”