Nimodipin versus Magnesium als Vasospasmusprophylaxe bei der Behandlung von Patienten mit aneurysmatischer Subarachnoidalblutung

Abstract: Objective: The prophylactic use of nimodipine in patients
with aneurysmal subarachnoid hemorrhage (SAH) reduces the risk of
ischemic brain damage, however its efficacy appears rather
moderate. The question arises whether other types of calcium
antagonists offer better protection. Magnesium, nature's
physiologic calcium antagonist, is neuroprotective in animal
models, promotes dilatation of cerebral arteries, and has an
established safety profile. The aim of the current study is to
evaluate the efficacy of magnesium versus nimodipine to prevent
delayed ischemic deficits after aneurysmal SAH. Methods: 113
patients with aneurysmal SAH were enrolled in the study and
randomized to receive either magnesium sulfate (loading 10 mg/kg
followed by 30 mg/kg/d) or nimodipine (48 mg/d) intravenously until
postoperative day 7. Primary parameters were blood flow velocity as
determined by daily transcranial Doppler (TCD), incidence of
vasospasm and infarction, and outcome at discharge. Results: 104
patients met the study requirements. In the magnesium group (N=53)
8 patients (15%) developed symptomatic and 20 patients (38%)
asymptomatic vasospasm according to TCD criteria compared to 14
(27%) and 17 (33%) patients in nimodipine the group (N=51). If
symptomatic vasospasm occurred, 75% of the magnesium-treated versus
50% of the nimodipine-treated patients developed cerebral
infarction resulting in fatal outcome in 37% and 14%, respectively.
Overall there was no difference in outcome between groups.
Conclusion: The observed trend towards a lesser incidence of
symptomatic vasospasm in magnesium-treated patients and the lesser
incidence of fatal outcome from symptomatic vasospasm in
nimodipine-treated patients make future studies on the combined
administration of magnesium and nimodipine appear promising.