Skip to main content
SpringerLink
Log in

Effect of Nimodipine on the Cerebral Circulation and Acute Ischemic Stroke

  • Chapter
New Trends in Diagnosis and Management of Stroke

Abstract

Current research suggests that cerebral ischemia induces a cascade of pathophysiological reactions, with a massive influx of calcium into the neuron as the “final common pathway”, resulting in catabolism and cell necrosis due to calcium overload. Treatment with calcium entry blockers, therefore, may be a new approach to arresting, and possibly preventing, destruction of cerebral tissue in stroke patients. The calcium entry blocker nimodipine was found to inhibit selectively spasms of the isolated cerebral arteries, produced either by depolarization or by receptor stimulation. In vivo experiments demonstrated that postischemic impairment of cerebral blood flow, which may be a major contributor to neuronal damage, is prevented.

After encouraging, although not conclusive, results of a single-blind pilot study, further clinical studies were undertaken and a double-blind, placebo-controlled, multicenter study was conducted. The data from this study strongly suggest that patients with acute ischemic stroke benefit from treatment with 120 mg nimodipine, started with 24 h after onset, combined with a “Standard” treatment, e. g., hemodilution by low molecular weight dextran. The conclusion so far is that calcium entry blockers such as nimodipine, may be useful in the treatment of patients with acute ischemic stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Hossmann KA, Zimmerman V (1974) Resuscitation of brain after one hour of complete ischemia. Brain Res 81: 59–74

    Article  PubMed  CAS  Google Scholar 

  2. Astrup J, Symon L, Branston NM, Lassen NA (1979) Cortical evoked potentials of brain ischemia. Stroke 8: 51–57

    Article  Google Scholar 

  3. Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia. The ischemic penumbra. Stroke 12: 723–725

    Article  PubMed  CAS  Google Scholar 

  4. Siesjo BK (1981) Cell damage in the brain: a speculative hypothesis. J Cereb Blood Flow Metab 1: 155–186

    Article  PubMed  CAS  Google Scholar 

  5. Hass WK (1981) Beyond cerebral blood flow, metabolism and ischemic thresholds: an examination of the role of calcium in the initiation of cerebral infarction. In: Meyer JS, Lechner H, Reivich M, Ott EO, Arabinar A (eds) Cerebral vascular disease, vol 3, Proceedings of the 10th Salzburg conference on cerebral vascular disease. Exerpta Medica, Amsterdam, pp 3–17

    Google Scholar 

  6. Godfraind T (1984) Basic mechanisms and classification of calcium entry blockers. In: Godfraind T, Herman AG, Wellens D (eds) Calcium entry blockers in cardiovascular and cerebral dysfunctions. Martinus Nijhoff, The Hague, pp 9–18

    Google Scholar 

  7. Towart R (1981) The selective inhibition of serotonin-induced contractions of rabbit cerebral vascular smooth muscle by calcium-antagonistic dihydropyridines. Circ Res 18: 650–657

    Google Scholar 

  8. White RP, Cunningham MP, Robertson JT (1982) Effect of the calcium antagonist nimodipine on the contractile responses of isolated canine basilar arteries induced by serotonin, prostaglandin F2a, thrombin and whole blood. Neurosurgery 10: 344–348

    Article  PubMed  CAS  Google Scholar 

  9. Kazda S, Garthoff B, Luckhaus G (1983) Calcium antagonists prevent brain damage in stroke prone spontaneously hypertensive rats. J Cereb Blood Flow Metab 3: 526–527

    Google Scholar 

  10. Kazda S, Hoffmeister F (1979) Effect of some cerebral vasodilators on the postischemic impaired cerebral perfusion in cats. Acta Pharmacol (Suppl)307: R43

    Google Scholar 

  11. Kazda S, Garthoff B, Krause WP, Schlossman K (1982) Cerebrovascular effects of the calcium antagonistic dihydropyridine derivate nimodipine in animal experiments. Arzneimittelforsch 32: 331–338

    PubMed  CAS  Google Scholar 

  12. Steen PA, Newberg LA, Milde JH, Michenfelder JD (1983) Nimodipine improves cerebral blood flow and neurologic recovery after complete ischemia in the dog. J Cereb Blood Flow Metab 3: 38–43

    Article  PubMed  CAS  Google Scholar 

  13. Newberg LA, Steen PA, Milde JH et al. (1984) Effects of nimodipine on cerebral blood flow and neurologic function following complete global ischemia in dogs and primates. In: Betz E, Deck K, Hoffmeister F (eds) First international nimotop symposium. Schattauer, Stuttgart, pp 99–10

    Google Scholar 

  14. Taylor DG, Kowalski TE (1984) Comparison of calcium channel inhibitors on vagal heart rate responses elicited by arterial baroreceptor reflexes in anaesthesized dogs. J Pharmacol Exp Ther 228: 491–499

    PubMed  CAS  Google Scholar 

  15. Paulson OB, Lassen NA, Skinhoj E (1970) Regional cerebral blood flow in apoplexy without arterial occlusion. Neurology 20: 125–138

    PubMed  CAS  Google Scholar 

  16. Lassen NA (1966) The luxury perfusion syndrome and its possible relation to acute metabolic acidosis localised within the brain. Lancet ii:1113 –1116

    Google Scholar 

  17. Fieschi C, Aguoli A, Principe M, Battistini N, Bozzao L, Nardini M (1969) Impairment of the regional vasomotor response of central vessels to hypercarbia in vascular diseases. Eur Neurol 2: 13–20

    Article  PubMed  CAS  Google Scholar 

  18. Paulson OB, Lassen MA, Skinhoj E (1970) Regional cerebral blood flow in apoplexy without atrial occlusion. Neurology 20: 125–138

    PubMed  CAS  Google Scholar 

  19. Gaab MR, Brawanski A, Bockhorn J, Maximilian VA (1982) Calcium antagonism: a new therapeutic principle in stroke and cerebral vasospasm? Reg Cerebral Blood Flow Bull (Novo Copenhagen) 3: 47–51

    Google Scholar 

  20. Gelmers HJ (1982) Effect of nimodipine on postischemic cerebrovascular reactivity, as revealed by measuring regional cerebral blood flow (rCBF). Acta Neurochir 63: 283–290

    Article  CAS  Google Scholar 

  21. Gelmers HJ (1984) The effect of nimodipine on the clinical course of patients with acute ischemic stroke. Acta Neurol Scand 69: 232–239

    Article  PubMed  CAS  Google Scholar 

  22. Gelmers HJ, Gorter K, de Weerdt CJ, Wiezer HJA (1985) Acute ischemic stroke: a controlled trial with the calcium antagonist nimodipine. J Cereb Blood Flow Metab 5 (suppl 1): S337

    Google Scholar 

  23. Schanne FAK, Kane AB, Young EE et al. (1979) Calcium dependence of toxic cell death: a final common path. Science 20: 700–702

    Article  Google Scholar 

  24. Capildeo R, Haberman S, Rose CF (1982) Stroke trials: the facts. In: Rose CF (ed) Advances in stroke therapy. Raven, New York, pp 53–62

    Google Scholar 

  25. Hinds CJ (1985) Brain ischemia. Br Med J 291: 758–760

    Article  CAS  Google Scholar 

  26. Mathew NT, Meyer JS, Rivera VH (1972) Double blind evaluation of glycerol treatment in acute cerebral infarction. Lancet ii: 1327–1333

    Google Scholar 

  27. Gelmers HJ (1975) Effect of glycerol treatment on the natural history of acute cerebral infarction. Clin Neurol Neurosurg 78: 277–282

    Article  PubMed  CAS  Google Scholar 

  28. Wood JH, Kee DB Jr (1985) Hemorrheology of the cerebral circulation in stroke. Stroke 16: 765–772

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Streekziekenhuis, 7607 PP, Almelo, The Netherlands

    H. J. Gelmers, J. H. A. Wiezer, C. J. de Weerdt & K. Gorter

Authors
  1. H. J. Gelmers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. A. Wiezer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. J. de Weerdt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Gorter
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Abteilung Neurologie der Medizinischen Fakultät, Rheinisch-Westfälische-Hochschule, Pauwelsstraße, D-5100, Aachen, Germany

    Klaus Poeck  & Erich Bernd Ringelstein  & 

  2. Abteilung Neurologie, Universität Heidelberg Kopfklinikum, Im Neuenheimer Feld 400, D-6900, Heidelberg, Germany

    Werner Hacke

Rights and permissions

Reprints and permissions

Copyright information

© 1987 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Gelmers, H.J., Wiezer, J.H.A., de Weerdt, C.J., Gorter, K. (1987). Effect of Nimodipine on the Cerebral Circulation and Acute Ischemic Stroke. In: Poeck, K., Ringelstein, E.B., Hacke, W. (eds) New Trends in Diagnosis and Management of Stroke. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72996-6_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-72996-6_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-18369-3

  • Online ISBN: 978-3-642-72996-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation