Experience with nimodipine in aneurysmal subarachnoid haemorrhage.

OBJECTIVES

To assess the efficacy of nimodipine in preventing delayed ischaemic deficit in aneurysmal subarachnoid haemorrhage.

DESIGN

A continuous prospective audit of all patients with aneurysmal subarachnoid haemorrhage admitted to the joint neurosurgery units of Prince Henry's and Alfred hospitals, Melbourne. Patients were divided into two groups--135 in the pre-nimodipine group during 1986 to 1989, and 73 in the nimodipine group during 1989 and 1990.

MAIN OUTCOME MEASURES

Outcome was measured according to the Glasgow outcome scale and the incidence of delayed ischaemic deficit was recorded.

RESULTS

A substantial reduction in the overall incidence of poor outcome was observed, from 37% of patients in the non-nimodipine group, to 20% in the nimodipine group (P = 0.022). Delayed ischaemic deficit occurred in 41% and 21% (P = 0.005), and poor outcome due to delayed ischaemic deficit occurred in 18% and 8% (P = 0.09) respectively.

CONCLUSIONS

In our experience, nimodipine appears to have substantially reduced the incidence of delayed ischaemic deficits in patients with aneurysmal subarachnoid haemorrhage, with a resultant improvement in overall patient outcome.