Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
Ville Soppi, Petros Nikolaos Karamanakos, Timo Koivisto, Mitja Ilari Kurki, Ritva Vanninen, ...
ObjectiveDelayed ischemic neurologic deficit (DIND) is a serious complication of acute aneurysmal subarachnoid hemorrhage (aSAH). Even though oral nimodipine is accepted as standard care for the prevention of DIND, the intravenous route is preferred by several centers. In the present study we compared the clinical efficacy between enteral and intravenous nimodipine after aSAH.Methods171 aSAH patients were randomly assigned to either enteral (84 patients) or intravenous (87 patients) nimodipine group and were compared regarding the incidence of DIND, number of new ischemic lesions on 12-month brain MRI, and clinical outcome 12 months after aSAH as assessed by Glasgow Outcome Scale (GOS), modified Rankin Scale (mRS), and Karnofsky scale. Health related quality of life (HRQoL) was also assessed by the 15D questionnaire 12 months post-aSAH.ResultsThe incidence of DIND did not differ significantly between the groups (20% in the enteral versus 16% in the intravenous group,P= 0.61), while no differences were observed neither in the number of new ischemic lesions (34% in both groups,P= 0.99), nor in the clinical outcome 12 months post-aSAH (P= 0.34 for GOS,P= 0.74 for mRS, andP= 0.71 for Karnofsky scale). The mean 15D HRQoL sums were also similar in the two groups (P= 0.43).ConclusionOur pilot study suggested no differences in the clinical efficacy of enteral and intravenous nimodipine after aSAH. However, a much larger phase III clinical trial would be needed to show or exclude meaningful clinical differences.
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