Abstract
Objective: Cerebral vasospasm remains an important cause of permanent neurological injury and
death following aneurysmal subarachnoid haemorrhage, despite the best current medical
therapy. Sodium nitroprusside was recently suggested as a treatment option for cerebral
ischaemia in patients with severe medically refractive vasospasm after subarachnoid
haemorrhage.
Methods: Twenty patients of aneurysmal SAH with severe vasospasm, corroborated on transcranial
Doppler (TCD), were included in this prospective study. The neurological condition
of all patients was classified as Hess and Hunt grade II or higher. The diagnosis
of severe delayed cerebral vasospasm refractory to conventional treatment (HHH therapy
and nimodipine) was established before treatment. Ten patients received intraventricular
sodium nitroprusside (SNP), while the other 10 had either major systemic illness or
did not consent, formed the control group of the study. SNP was instilled in escalating
doses with a starting dose of 4 mg/mL and reversal of vasospasm was monitored on neurological
examination along with TCD in a basic ICU setting without the need for neurophysiological
or invasive monitoring.
Results: All patients in the study group showed an improvement in TCD velocities post-SNP
instillation. Adverse effects were vomiting and hypotension in the SNP group which
responded to medical management. The overall neurological outcome was good or excellent
in 7/10 patients in the SNP group. Comparison between the two groups revealed improvement
in TCD velocities and GCS in the SNP group thus affecting the long-term prognosis.
Conclusion: Intraventricular sodium nitroprusside represents a promising method of treatment
for established delayed cerebral vasospasm and cerebral ischaemia refractory to conventional
treatment.
Key words
delayed cerebral vasospasm - subarachnoid hemorrhage - intraventricular sodium nitroprusside
References
Correspondence
neuro.abhi@yahoo.co.in
