gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Observations on the influence of magnesium sulfate versus nimodipine on ischaemic lesions after aneurysmatic subarachnoidal hemorrhage

Beobachtungen zur Rolle von Nimodipin versus Magnesium zur Vasospasmusprophylaxe bei aneurysmenrupturbedingter Subarachnoidalblutung

Meeting Abstract

  • corresponding author C. P. G. Heinen - Neurosurgical Department, University of Ulm/Günzburg
  • G. Antoniadis - Neurosurgical Department, University of Ulm/Günzburg
  • K. Seitz - Neurosurgical Department, University of Ulm/Günzburg
  • H.-P. Richter - Neurosurgical Department, University of Ulm/Günzburg
  • W. Börm - Neurosurgical Department, University of Ulm/Günzburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP076

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0344.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Heinen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Cerebral infarction due to vasospasm represents a severe complication following aneurysmatic subarachnoidal hemorrhage (SAH). According to a cochrane review it is unclear whether intravenous nimodipine prevents ischaemic neurological deficits, and only oral nimodipine is recommended based on the present evidence. Recently magnesium sulfate, given intravenously, has been investigated as a potential alternative. We report the results of an observational study comparing SAH-patients who received different calciumantagonist regimens.

Methods

57 patients treated for SAH due to ruptured aneurysms between July 2002 and June 2003 were included in this retrospective non-randomized study. 33 patients received i.v. nimodipine (group I), 16 patients i.v.Mg++ (group II), 8 patients were treated with a combination of both (group III). The groups were comparable for Hunt/Hess and Fisher grades, clipping or coiling, as well as for gender and age. We investigated the occurrence of new cerebral infarcts, which were defined as new and persistent hypodensities on CCT. Additionally we compared mean-flow velocities higher than 120 cm/sec in transcranial doppler (TCD).

Results

In group I 18/33 patients and in group II 8/16 had new infarctions, whereas in group III there was 1/8 patient. Statistical analysis revealed no difference between the nimodipine group vs. the MG++ group (p=0,73, Fisher`s exact test) whereas there was a significant difference between the nimodipine group and the combination group (p=0,04) and a trend towards better result for the combination group versus the MG++ group (p=0,09) despite these low patient numbers. Mean flow velocities >120 cm/sec in TCD showed lower infarction rates in the combination group (p=0,056 and p=0,073, respectively).

Conclusions

These preliminary data revealed differences in the rate of new ischaemic lesions after aneurymatic subarachnoidal hemorrhage when treated with a combination of nimodipine and MG++ intravenously compared to a standard regimen. No difference was found when either nimodipine or MG++ was given. Mean flow velocities in TCD as a possible predictor of ischaemic events were also reduced when a combination therapy was applied. These results warrant further studies on the role of nimodipine and/or MG++ in the prevention of vasospasm- induced ischaemia.