Article Figures & Data
Figures
- Fig 1.
Case 25. This patient presented with a decreased level of consciousness and was treated with intra-arterial nimodipine for symptomatic cerebral vasospasm following SAH.
A and B, Anteroposterior (A) and lateral (B) angiograms of the left internal carotid artery show vasospasm at the level of the carotid siphon, the terminal internal carotid artery, the A1 segment of the ACA, and the MCA.
C and D, Anteroposterior (C) and lateral (D) angiograms obtained after intra-arterial injection of nimodipine 3 mg into the internal carotid artery demonstrate an increased diameter of the vessels. The patient’s clinical condition rapidly improved after treatment.
- Fig 2.
Case 4. This patient with right hemiparesis was treated with intra-arterial nimodipine for symptomatic cerebral vasospasm following SAH. This patient had moderate vasospasm of tICA, ACA and MCA on the left side.
A, Lateral angiogram of the left internal carotid artery shows vasospasm involving also the distal cerebral branches (arrows).
B, Lateral angiogram of the left internal carotid artery obtained after the intra-arterial injection of nimodipine 2 mg shows a slight increase in the size of the distal arteries (arrows) and the internal carotid system. Despite the poor angiographic results, the patient’s condition improved significantly within 12 hours, and no recurrence of symptoms was observed.
- Fig 3.
Case 12. Patient presenting with left hemiparesis and diffuse and severe vasospasm. After an intra-arterial injection of 3 mg of nimodipine into both carotid arteries and the basilar artery, angiographic and clinical results were poor. A second session with injection of 5 mg of nimodipine into the same vessels achieved good angiographic results and clinical improvement.
A, This angiogram obtained before the intra-arterial injection of nimodipine shows a moderate vasospasm of the left vertebral artery. (Vasospasm was severe in the other vessels, not shown.)
B, After nimodipine therapy, this left vertebral artery angiogram shows increased size of the basilar artery. Despite these results, the patient later died from cardiopulmonary complications.
Tables
Patient/Sex/Age, y WFNS Grade at Admission Fischer Score Location of Aneurysm* Aneurysm Treatment 1/F/42 II 3 R Pcom Endovascular 2/M/48 IV 4 L MCA Surgery 3/M/50 III 3 Acom Surgery 4/F/48 I 2 L MCA Surgery 5/F/46 V 4 Acom Endovascular 6/F/37 V 4 L MCA Surgery 7/M/55 II 3 L MCA Endovascular 8/F/38 I 3 L Pcom Surgery 9/F/47 IV 3 Acom Surgery 10/M/51 III 2 Acom Endovascular 11/M/44 I 4 R MCA Surgery 12/F/51 I 3 BA Endovascular 13/F/53 II 3 R MCA Surgery 14/F/46 I 3 R PCA Endovascular 15/F/43 II 4 Acom Endovascular 16/F/32 II 4 R Pcom Endovascular 17/F/34 IV 2 R MCA Endovascular 18/F/55 II 3 Acom Surgery 19/M/57 II 3 Acom Endovascular 20/F/32 IV 3 L Pcom Endovascular 21/F/39 I 3 AchoA Surgery 22/F/63 IV 4 Acom Surgery 23/F/51 I 3 R Pcom Surgery 24/F/52 I 4 Acom Surgery 25/F/57 II 3 L MCA Surgery * AchoA indicates anterior choroidal artery; Acom, anterior communicating artery complex; BA, basilar artery apex; MCA, middle cerebral artery; PCA, posterior cerebral artery (P1 segment); and Pcom, posterior communicating artery.
- TABLE 2:
Data in 25 patients treated with intra-arterial nimodipine for symptomatic cerebral vasospasm after SAH
Pt/No. of Tx Indication for Angiography Days after SAH Symptom Onset after Spasm, h Vessel with Spasm Side Spasm Severity Vessel Infused Nimodipine Dose per Session, mg SAP Change, mm Hg Angio-graphic Results Clinical Results GOS Score Modified Rankin Score 1/1 Decreased LOC 6 18 tICA, MCA R Moderate ICA R 1.0 0 Good Improved 2 2 2/1 Decreased LOC 7 18 tICA, MCA, ACA L Severe ICA L 1.0 −10 Excellent Improved 1 1 3/1 Decreased LOC 6 24 tICA, MCA, ACA R/L Moderate ICA R/L 3.0 −15 Poor Unchanged 3 3 4/1 R hemiparesis 7 18 tICA, MCA, ACA L Moderate ICA L 2.0 −10 Poor Improved 1 0 5/1 L hemiparesis 8 24 ACA R Mild ICA R 1.0 0 Good Improved 2 2 6/2 L MCA > 200 cm/s 7 6 tICA, MCA, ACA L Severe ICA L 2.0 −20 Poor Unchanged 6* R hemiparesis 9 24 tICA, MCA, ACA L Severe ICA L 3.0 −20 Good Unchanged* 3 3 7/1 Dysphasia 10 12 MCA L Mild ICA L 3.0 −15 Poor Improved 1 0 8/1 Disorientation 9 24 tICA, MCA, ACA L Severe ICA L 2.0 −20 Poor Improved 1 0 9/1 Decreased LOC 5 18 tICA, MCA L Moderate ICA L 1.0 10 Good Improved 3 3 10/1 R-leg monoparesis 15 18 ACA L Mild ICA L 2.0 −15 Good Improved 1 0 11/1 Decreased LOC 6 24 tICA, ACA R Moderate ICA R 2.0 −30 Good Improved 2 2 12/2 L hemiparesis 7 12 Diffuse R/L Severe ICA R/L, VA L 3.0 −20 Poor Unchanged 12* L hemiparesis 8 24 Diffuse R/L Severe ICA R/L, VA L 5.0 −30 Good Improved* 5 6 13/1 Decreased LOC 4 12 tICA, MCA, ACA R/L Moderate ICA R/L 3.0 −30 Poor Unchanged 5 6 14/2 Cranial nerve III paresis 11 18 BA, PCA R Moderate VA L 3.0 −20 Poor Unchanged 14* Cranial nerve III paresis 12 24 BA, PCA R Moderate VA L 2.0 −25 Poor Improved* 1 0 15/1 Dysphasia, temp >38°C 7 12 MCA, ACA R/L Moderate ICA R/L 2.0 −10 Poor Unchanged 2 2 16/1 Decreased LOC, disorientation 5 12 Diffuse R/L Severe ICA R/L, VA 3.0 −20 Good Improved 2 2 17/1 Decreased LOC disorientation 10 24 tICA, MCA, ACA R Moderate ICA R 2.0 0 Good Improved 1 1 18/1 R/L MCA > 190 cm/s 11 18 tICA, MCA, ACA L Moderate ICA L 2.0 −20 Poor Unchanged 3 3 19/1 Decreased LOC 10 24 Diffuse R/L Severe ICA R/L VA 5.0 −35 Excellent Improved 2 2 20/3 Decreased LOC 4 12 tICA, MCA, ACA L Moderate ICA L 2.0 −30 Poor Unchanged 20* Decreased LOC, L MCA > 140 cm/s 5 24 tICA, MCA, ACA L Moderate ICA L 3.0 −25 Poor Unchanged* 20† Decreased LOC, L MCA > 160 cm/s 6 48 tICA, MCA, ACA L Severe ICA L 3.0 −40 Poor Improved† 1 0 21/1 L hemiparesis 8 24 tICA, MCA R Moderate ICA R 3.0 −10 Poor Improved 2 2 22/1 Decreased LOC 5 12 ACA R Severe ICA R 3.0 −15 Good Improved 2 2 23/1 Decreased LOC 6 6 tICA, ACA R Moderate ICA R 3.0 −25 Poor Improved 1 0 24/1 Decreased LOC 10 24 tICA, ACA L Moderate ICA L 2.0 −30 Poor Unchanged 3 3 25/1 Decreased LOC 5 12 tICA, MCA, ACA L Severe ICA L 3.0 −20 Good Improved 2 2 Note.—ACA indicates anterior cerebral artery; BA, basilar artery; GOS, Glasgow Outcome Scale (5 indicates death); ICA, internal carotid artery; LOC, level of consciousness; PCA, posterior cerebral artery; SAP, systolic artery pressure; Tx, treatment; and VA, vertebral artery.
* Second treatment.
† Third treatment.
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