Nimodipine and bradycardia in acute stroke--drug or disease?

A patient who had suffered an acute ischemic stroke experienced bradycardia while being treated with nimodipine 80 mg tid. This became evident after the initiation of nimodipine and progressed, leading to the drug being discontinued after three days of therapy. The bradycardia resolved shortly after the treatment was terminated and normal heart rate was maintained throughout 23 days of hospitalization and in subsequent outpatient follow-up. Although nimodipine-induced bradycardia is possible, hemispheric cerebral infarction may also cause transient bradyarrhythmias in the acute stroke period. There is a need to monitor the heart rate and rhythm of all acute stroke patients, especially those receiving nimodipine.