Ak. Papavasiliou et al., Clinical outcomes of aneurysmal subarachnoid hemorrhage patients treated with oral diltiazem and limited intensive care management, SURG NEUROL, 55(3), 2001, pp. 138-146
BACKGROUND
Aneurysmal subarachnoid hemorrhage (SAH) patients are frequently treated wi
th prophylactic nimodipine and undergo invasive monitoring of blood pressur
e and volume status in an intensive care unit (ICU) setting to decrease the
incidence of delayed ischemic neurological deficit (DIND) and improve func
tional outcomes. The goal of this study was to examine the incidence of DIN
D and poor functional outcomes in a consecutive series of SAH patients trea
ted with a different regimen of prophylactic oral diltiazem and limited use
of intensive care monitoring.
METHODS
The study involved a consecutive series of 123 aneurysmal SAH patients trea
ted by the senior author who were admitted within 72 hours of hemorrhage an
d who never received nimodipine or nicardipine. Functional outcomes were gr
aded using the Glasgow Outcome Scale (GOS).
RESULTS
Of the 123 patients identified, favorable outcomes (GOS 4 and 5) were achie
ved in 74.8%. The incidence of DIND was 19.5%. Hypertensive, hypervolemic,
hemodilutional (HHH) therapy was used in 10 patients (8.1%) and no patients
were treated for DIND by endovascular means. Seven patients (5.7%) had a p
oor functional outcome or death because of DIND and two of these were relat
ed to complications of HHH therapy. These results were com-pared to contemp
orary series of SAH patients managed with other treatment protocols.
CONCLUSIONS
Functional outcomes of patients treated with a regimen of oral diltiazem, l
imited use of ICU monitoring and HHH therapy for DIND compare favorably wit
h other contemporary series of SAH patients. (C) 2001 by Elsevier Science I
nc.