ANEURYSMAL SUBARACHNOID HEMORRHAGES WITH AND WITHOUT NIMODIPINE - A COMPARATIVE-STUDY WITH AN ANALYSIS OF THE TEMPERATURE CURVE

A total of 210 consecutive patients with aneurysmal subarachnoid hemor rhage (S.A.H.) of any clinical grade admitted from january 1985 throug h may 1990 were retrospectively studied to determine the effect of int ravenous Nimodipine on survival and functional results and to analyse temperature curve as a prognosis factor. The 106 patients admitted fro m january 1985 through november 1987 constituted the reference series termed G1. The 104 patients admitted from december 1987 through may 19 90 and treated with intravenous Nimodipine constituted the series term ed G2. Of the 210 patients, 172 (82%) could be operated on with simila r mean operative delay in both series (G1 = 9,5 days, G2 = 9,8 days). Of the 210 patients, 153 (73%) survived with an average follow-up of 1 11 weeks for G1 and of 64 weeks for G2. Nimodipine treatment was assoc iated with a significant increase of survival (11,8%, P = 0,05) which was not the result of improved operative technique but of a lower inci dence of deaths caused by postoperative vasospasm (G1 = 5 deaths, G2 = 0 deaths, P = 0,05) and by rebleeding (G1 = 15 deaths, G2 = 5 deaths, P = 0,03). No significant difference between the two series G1 and G2 was observed regarding functional results in the 153 survivors, frequ ency and seriousness of clinical signs of vasospasm during the waiting phase for surgery, radiologic signs of vasospasm on initial and secon d angiography, cerebral infarctus on second C.T.-Scan. Analysis of tem perature curves of the 210 patients revealed that a delayed fever with a plateau pattern was associated with a higher incidence of vasospasm , rebleeding, and deaths. Nevertheless 73% of survivors with such a pl ateau type of temperature curve had finally a good functional result. Nimodipine reduced mortality caused by postoperative vasospasm in a se ries of patients with delayed surgery but did not change other paramet ers of vasospasm, i.e. preoperative clinical signs and radiologic sips on angiography and C.T.-Scan. The important decrease of rebleeding in the series with Nimodipine is amazing and unexplained but has certain ly to be emphasized for several authors already noticed it. Lastly a d elayed fever with a plateau pattern is really associated with a lower prognosis but temperature curve cannot be considered as the unique gui de in operative timing.