gms | German Medical Science

Objective: Development of vasospasm after aneurysmatic subarachnoid hemorrhage (aSAH) is closely linked to the development of delayed cerebral ischemia (DCI), which is a major contributor to unfavorable outcome after aSAH. Despite having been available for more than a decade, the effect of local intraarterial administration of nimodipine as a rescue measure on clinical outcome remains understudied; therefore, we evaluated it`s effect on short and long term functional and neuropsychological outcome after aSAH.

Methods: A total of 107 consecutive patients treated for aSAH on the neurosurgical intensive care unit of our university hospital according to the local standard of care were recruited. Follow-up was conducted at three, twelve and 24 months after the hemorrhage. At follow-up visits, functional outcome was assessed by extended Glasgow Outcome Scale (GOSE) and mRS, while neurocognitive function was evaluated using the screening module of the Neuropsychological Assessment Battery (NAB-S). Outcome of patients, who received rescue therapy (intervention group, n=37), and those, who were treated conservatively (control group, n=70), was compared.

Results: Even though significantly more patients in the interventional treatment group suffered from high grade aSAH (WFNS Grade IV + V) compared to the control group (54.1% vs. 31.4%, p=0.04), significant differences in functional outcome were present only at discharge and three months after the bleeding (GOSE >4 in 8.1% vs. 41.4% and 28.6% vs. 72.7%, p<0.001 and p=0.01, respectively). Thereafter, group differences were no longer significant. The same temporal pattern of recovery could be seen when assessing severe neuropsychological deficits and the ability to return to work: While significantly more patients in the intervention group had severe neuropsychological deficits (76.3% vs. 36.0% and 66.7% vs. 26.1%, p=0.04 and 0.03, respectively) and were unable to work (5.9% vs. 40.0%, p=0.02 at twelve months) at three and twelve months after the hemorrhage, no significant differences between the two groups could be detected at long term follow up. The presence of moderate neuropsychological impairments did not significantly differ between the groups at any timepoint.

Conclusion: Intraarterial administration of nimodipine as a rescue measure to treat vasospasm moderately improves functional as well as neuropsychological outcome and professional reintegration after aSAH.