Comparison of Nimodipine Administration Routes in Cerebral Vasospasm After Subarachnoid Hemorrhage

Background and purpose: Increasingly numerous studies have indicated that nimodipine can be recommended as an effective and safe agent for the treatment of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). However, data regarding its delivery route in the treatment of aSAH are inconsistent. The aim of this study was to assess and compare the effects of different administration routes on the functional improvement of patients with aSAH. Methods: We retrospectively reviewed 27 patients with aSAH. Of these 27 patients, 2 had intraventricular bleeding and 10 had cerebral hematoma. All patients were divided into 3 groups as follows: the topically applied nimodipine group, the systemically applied nimodipine group and the control group. Patients were treated with nimodipine and the neurological status at discharge and at 3 months were recorded. Transcranial doppler sonography (TCD) was used to monitor cerebral vasospasm following surgical clipping. Liver function and intracranial infection were assessed among three groups. Results: The blood flow velocity was significantly increased at days 1, 5 to days 7, 10 and day 14 after surgery in the topically applied nimodipine group. 2 out of 10 (20%) patients had intracranial infection in the topically applied nimodipine group. There were no intracranial infections in the systemically applied nimodipine group and the control group. Conclusion: Different administration routes may affect the functional improvement in patients with aSAH. The combined use of systemically and topically applied nimodipine may be effective for treatment of cerebral vasospasm following surgical clipping of aneurysms.