Introduction: Subarachnoid hemorrhages (SAH) are only a small percentage of strokes (3-5%) but affect the younger population more than any other stroke and have a very high mortality and morbidity. 10-15% of patients die, never reaching the hospital and the mortality rates of those reaching medical treatment can be greater than 50% within the first 2 weeks of presentation due to complications of the SAH including cerebral vasospasm. Among aSAH patients with successful treatment of the aneurysm, approximately 66% will have residual morbidity and never return to the same quality of life due to Delayed Ischemic Neurologic Deficit (DIND) as a result of cerebral vasospasm. Effective medical therapies remain limited for these patients and more invasive approaches such as a cerebral angiogram for intraarterial verapamil injection or angioplasty are sometimes required. Intraventricular nicardipine is a safe alternative for treatment of cerebral vasospasm. We report our experience with intraventricular nicardipine in aSAH with refractory cerebral vasospasm.

Methods: We performed a retrospective review of all aSAH patients from June 30, 2013 to July 1, 2014 who had vasospasm documented either by Transcranial Dopplers (TCD) or a clinical decline in neurological examination. The effectiveness of intraventricular nicardipine on short term clinical outcome, improvement in neurological exam, angiographic vasospasm, or TCD velocities/Lindegaard ratio as well as documented delayed neurological injury (stroke) as a result of the vasospasm were assessed in patients who received treatment.

Results: 8 patients who received treatment were included in the chart review. Intraventricular nicardpine was started between day 6 - 14 after SAH and duration of treatment was 3 - 8 days. All patients had good neurological outcome and there was no increase in infection with medication administration.

Conclusions: Intraventricular nicardipine is safe and could represent an effective adjunctive medical treatment in the management of patients with severe cerebral vasospasm.

Patient Care: This research shows that intraventricular nicardipine can be an effective treatment in the management of aSAH patients with cerebral vasospasm.

Learning Objectives: By the conclusion of this session, participants would be able to identify that intraventricular administration of nicardipine can be effective in the treatment of cerebral vasospasm and associated delayed ischemic neurologic deficit.

References: Weyer GW, Nolan CP, Macdonald RL: Evidence-based cerebral vasospasm management. Neurosurg Focus. 2006 Sep 15;21(3):E8. Hop JW, Rinkel GJ, Algra A, et al: Case-fatality rates and functional outcome after subarachnoid hemorrhage: A systematic review. Stroke 28: 660-4, 1997 Drake CG: Management of cerebral aneurysm. Stroke 12: 273-83, 1981 Weir B, Grace M, Hansen J, et al.: Time course of vasospasm in man. J.Neurosurg 48:173-8, 1978 Findlay JM: Current management of cerebral vasospasm. Contemp Neurosurg 19 (24): 1-6, 1997