Abstract
Effect of high doses of nicardipine on cerebral vasospasm was studied in patients with ruptured aneurysms. Twenty patients were treated with nicardipine (Group A), whereas 21 patients did not receive the drug (Group B). Intravenous infusion of nicardipine started within 24 hours after subarachnoid hemorrhage (SAH) in 18 cases, and on Day 4 and Day 5 in 2 cases, respectively. The dosage was 3mg/hr in 3 cases, 5mg/hr in 4, 7mg/hr in 7, and 10mg/hr in 6, for 9 to 21 days. Early surgery was performed within 72 hours after SAH in 15 cases in Group A and 16 cases in Group B, and other cases in both groups had delayed operation. Postoperative angiography was carried out 8 to 16 days after SAH in 15 cases in Group A and 16 cases in Group B. The flow velocity in middle cerebral artery was recorded with transcranial Doppler sonography every other day in 18 cases in Group A and all cases in Group B.
No patients in Group A demonstrated ischemic symptoms and low-density areas on CT scans, while high incidences of brain ischemia (48%) and low-density areas on CT scans (43%) were noted in Group B patients. Severe angiographic vasospasm was shown in 7 of 16 patients in Group B, but was not found in any patients in Group A. Statistically significant increase in mean blood flow velocity in the M1 segment was noted by transcranial Doppler sonography on Day 6, Day 8, and Day 10 in Group B.
The present study demonstrated that intravenous infusion of high doses of nicardipine had significantly beneficial effects on development of brain ischemia and angiographic vasospasm after aneurysmal SAH. Early treatment with nicardipine might be essential to prevent delayed cerebral vasospasm.
