The efficacy of an abbreviated course of nimodipine in patients with good-grade aneurysmal subarachnoid hemorrhage

Object. Nimodipine therapy has become a standard component of the treatment regimen used in patients with aneurysmal subarachnoid hemorrhage (SAH). Its prescribed use at 60 mg every 4 hours for 21 days is based on reputable, randomized prospective studies. However, because only 20 to 30% of patients with SAH suffer clinical cerebral vasospasm, it is clear that most patients do not actually need the drug. Of course, this fact is not evident until several treatment days have passed. It is common practice, without well-documented consequences, to terminate nimodipine therapy before 21 days in certain clinical circumstances. The aim of this study was to evaluate the effectiveness of abbreviating the duration of nimodipine treatment in the setting of a good-grade aneurysmal SAH. Methods. A retrospective clinical review was made of 90 consecutive patients who experienced a Hunt and Hess Grade I through III aneurysmal SAH and were treated with nimodipine for 15 days or less. Conclusions. None of the patients studied suffered a delayed neurological deficit as a result of the abbreviated course of nimodipine.