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Intra-arterial nimodipine to treat symptomatic cerebral vasospasm following traumatic subarachnoid haemorrhage. Technical case report

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Summary

Intra-arterial Nimodipine administration can be an effective alternative to papaverine or balloon angioplasty for the treatment of cerebral vasospasm refractory to medical therapy. It has been used for intractable vasospasm due to aneurysmal subarachnoid haemorrhage (SAH) with convincing results and no significant complications in small case series. This report describes of a patient with symptomatic and angiographically documented vasospasm following traumatic SAH which was refractory to maximal medical therapy and successfully treated with intra-arterial infusion of Nimodipine. This first reported technical note is with special reference to the nimodipine administration modalities, clinical and neuroradiological criteria of selection as well as the follow up of the patient.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Messina, Policlinico Universitario, Via Consolare Valeria 1, 98125, Messina, Italy

    Alfredo Conti, Filippo Flavio Angileri & Giovanni La Rosa

  2. Department of Neuroradiology, University of Messina, Messina, Italy

    Marcello Longo, Antonio Pitrone & Francesca Granata

Authors
  1. Alfredo Conti
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  2. Filippo Flavio Angileri
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  3. Marcello Longo
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  4. Antonio Pitrone
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  5. Francesca Granata
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  6. Giovanni La Rosa
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Corresponding author

Correspondence to Alfredo Conti.

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Comments

Positive response of intra-arterial nimodipine (IAN) administration on severe cerebral vasospasm after aneurysmal SAH was demonstrated with additional correlation to cerebral perfusion (1). Conti et al. report here a case with IAN administration on traumatic SAH associated medically refractory vasospasm and could demonstrate both the technical feasibility and clinical effectiveness.

References

1. Hänggi D., Turowski B, Beseoglu K, Yong M, Steiger HJ (2008) Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid haemorrhage: influence on clinical course and cerebral Perfusion. AJNR 29: 1053–60

Michael Synowitz

Department of Neurosurgery

Charité-Universitätsmedizin Berlin

Germany

Comment

Authors report the case of a patient with symptomatic and angiographically documented vasospasm following traumatic SAH and was refractory to maximal medical therapy, but was successfully treated with intra-arterial infusion of nimodipine. Technical notes from this first case are described and reported with clinical and neuroradiological criteria for patient selection.

It is well-known that subarachnoid haemorrhage induced cerebral vasospasm complicates the treatment of patients with severe head injury. Similarly to patients with aneurysmal subarachnoid haemorrhage, the vasospasm initiates the third post-injury day with a peak occurrence from 7 to 12 days. Even though it is accepted that decreased cerebral blood flow and clinical deterioration can be the result of the vasospasm, this is the first reported head injured patient in which clinical symptoms definitely correlated with angiography, cerebral blood flow velocity (TCD) and cerebral blood flow (SPECT) documented vasospasm. The only concern is that based on clinical history and CT images the aneurysmal origin of the vasospasm cannot be 100% excluded, especially since 15–20% of SAH cases the angiography is unable to show the bleeding source (aneurysm).

P. Barzo

Albert Szent-Gyorgyi Medical University

Hungary

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Conti, A., Angileri, F.F., Longo, M. et al. Intra-arterial nimodipine to treat symptomatic cerebral vasospasm following traumatic subarachnoid haemorrhage. Technical case report. Acta Neurochir (Wien) 150, 1197–1202 (2008). https://doi.org/10.1007/s00701-008-0141-0

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  • DOI: https://doi.org/10.1007/s00701-008-0141-0

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