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Does nimodipine reduce mortality and secondary ischaemic events after subarachnoid haemorrhage?
  1. G Brown, Specialist Registrar,
  2. S Carley, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

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    Report by G Brown, Specialist RegistrarChecked by S Carley, Consultant

    Abstract

    A short cut review was carried out to establish whether nimodipine is better than placebo at reducing mortality and neurological sequelae in patients with subarachnoid haemorrhage. Altogether 465 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

    Clinical scenario

    A 24 year old man presents to the emergency department after a sudden headache and collapse. He presents with a GCS of 13 and a weakness of the left side. Computed tomography confirms a subarachnoid bleed. You refer him to the neurosurgeons who suggest giving him nimodipine to reduce cerebral vasospasm. You are too embarrassed to ask why.

    Three part question

    In [patients with proven subarachnoid haemorrhage] is [nimodipine better than placebo] at [resolving mortality and neurological sequelae]?

    Search strategy

    Medline 1966-01/04 using the Ovid interface. [subarachnoid.mp OR exp subarachnoid hemorrhage] AND [nimodipine.mp OR exp nimodipine] Limit to human, English AND abstracts.

    Search outcome

    Altogether 465 papers found. One recent Cochrane systematic review identified. No relevant papers published after the date of the systematic review. The review was critically appraised (see table 1).

    Table 1

    Comment(s)

    SAH is a devastating illness. Treatment with calcium antagonsits seems to offer a decrease in secondary ischaemic events in these patients. This is shown by the reduction in mortality and clinical findings. Although not specifically investigated in the BET, oral nimodipine appears to be the first choice of drug.

    CLINICAL BOTTOM LINE

    Oral nimodipine is an important adjuvant treatment for SAH.

    Report by G Brown, Specialist RegistrarChecked by S Carley, Consultant

    References

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