Experience with nimodipine in aneurysmal subarachnoid haemorrhage

OBJECTIVES: To assess the efficacy of nimodipine in preventing delayed ischaemic deficit in aneurysmal subarachnoid haemorrhage. DESIGN: A continuous prospective audit of all patients with aneurysmal subarachnoid haemorrhage admitted to the joint neurosurgery units of Prince Henry's and Alfred hospitals, Melbourne. Patients were divided into two groups--135 in the pre-nimodipine group during 1986 to 1989, and 73 in the nimodipine group during 1989 and 1990. MAIN OUTCOME MEASURES: Outcome was measured according to the Glasgow outcome scale and the incidence of delayed ischaemic deficit was recorded. RESULTS: A substantial reduction in the overall incidence of poor outcome was observed, from 37% of patients in the non-nimodipine group, to 20% in the nimodipine group (P = 0.022). Delayed ischaemic deficit occurred in 41% and 21% (P = 0.005), and poor outcome due to delayed ischaemic deficit occurred in 18% and 8% (P = 0.09) respectively. CONCLUSIONS: In our experience, nimodipine appears to have substantially reduced the incidence of delayed ischaemic deficits in patients with aneurysmal subarachnoid haemorrhage, with a resultant improvement in overall patient outcome.