Use of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm.

Abstract

BACKGROUND:

Cerebral vasospasm leading to delayed ischemia is a common and serious complication of aneurysmal subarachnoid hemorrhage that often results in increased morbidity and mortality. Treatments for cerebral vasospasm, including triple-H therapy (therapeutic hypervolemia, hypertension, and hemodilution), nimodipine, balloon angioplasty, and intra-arterial vasodilators have limitations in their efficacy and safety profiles. Nicardipine, a calcium channel blocker, is available for intravenous administration for blood pressure reduction. A recent study reported its efficacy in the treatment of cerebral vasospasm when given intrathecally (IT). We present our experiences with IT nicardipine for treatment of cerebral vasospasm.

METHODS:

IT nicardipine was administered to six patients with aneurysmal subarachnoid hemorrhage after prophylactic and aggressive therapeutic management for vasospasm failed.

RESULTS:

In these patients, IT nicardipine treatment was followed within 8 hours by a 43.1 +/- 31.0 cm/s decrease in middle cerebral arterial flow velocity, as measured by transcranial Doppler ultrasound.

CONCLUSIONS:

Based on these positive results, we believe that larger scale studies evaluating the safety and efficacy of IT nicardipine for the management of cerebral vasospasm are warranted.

• Authors: As'ad Ehtisham, Scott Taylor, Linda Bayless, Owen B Samuels, Michael W Klein, Jeff M Janzen
• Journal: Southern medical journal (South Med J) Vol. 102 Issue 2 Pg. 150-3 (Feb 2009) ISSN: 1541-8243 [Electronic] United States
• PMID: 19139684 (Publication Type: Case Reports, Journal Article)

Chemical References

• Calcium Channel Blockers
• Nicardipine

Topics

• Adult
• Calcium Channel Blockers (administration & dosage, therapeutic use)
• Female
• Humans
• Injections, Spinal
• Male
• Middle Aged
• Nicardipine (administration & dosage, therapeutic use)
• Subarachnoid Hemorrhage (complications, drug therapy)
• Vasospasm, Intracranial (drug therapy, etiology)