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[Effect of calcium antagonist (diltiazem) on symptomatic cerebral vasospasm--with special reference to CT
Insights
Diltiazem improved prognosis for patients with ruptured aneurysms, particularly those with Hunt-Hess grades II and III. This calcium channel blocker showed potential benefits in reducing symptomatic cerebral vasospasm based on CT grading.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Computed tomography (CT) is crucial for identifying subarachnoid and intracerebral hemorrhage.
- Subarachnoid clots near cerebral arteries are linked to cerebral vasospasm.
- Previous research indicated Diltiazem improved prognosis in ruptured aneurysm patients without affecting vasospasm severity.
Purpose of the Study:
- To re-examine the effect of Diltiazem on patients with ruptured supratentorial aneurysms.
- To assess Diltiazem's efficacy based on Fisher's CT grading system and Hunt-Hess grades.
Main Methods:
- 105 patients treated with Diltiazem post-operation were compared to 100 control patients operated on before Diltiazem administration.
- Patients were classified using Fisher's CT grading system.
- Hunt-Hess grade V patients were excluded; Diltiazem treatment lasted 2 weeks post-operation.
Main Results:
- Symptomatic cerebral vasospasm frequency tended to decrease in patients with CT grades 2 and 3.
- Prognosis significantly improved for the 105 patients receiving Diltiazem, including 32 with symptomatic vasospasm.
- Diltiazem appeared particularly effective for Hunt-Hess grades II and III with CT grades 2 and 3.
Conclusions:
- Diltiazem may offer significant prognostic benefits for specific ruptured aneurysm patient subgroups.
- CT grading (Fisher's system) and clinical severity (Hunt-Hess grades) can help identify patients likely to benefit from Diltiazem.
Abstract:
CT is important for detecting subarachnoid clots and intracerebral or intraventricular hemorrhage. The presence of subarachnoid clots surrounding the cerebral arteries may be one of the causes of cerebral vasospasm. It is agreed that there is a correspondence between the site of subarachnoid clots and the location of cerebral vasospasm. The authors have already reported that the appearance and severity of symptomatic cerebral vasospasm were not affected by calcium antagonists (Diltiazem), but the prognosis improved significantly for 105 patients (especially Hunt-Hess grade II and III) at the 3-month follow-up examination. In this study, the above 105 patients, each with a ruptured supratentorial aneurysm, were classified preoperatively according to Fisher's CT grading system and the effect of Diltiazem was re-examined. Patients in Hunt-Hess grade V were excluded and the duration of treatment with Diltiazem was 2 weeks following the operation. 105 cases (Diltiazem) were compared as a control group with 100 cases who were operated on before the administration of Diltiazem. The frequency of occurrence of symptomatic cerebral vasospasm tended to decline in patients with a CT grade of 2 or 3, and the prognosis improved significantly for 105 patients including 32 cases with symptomatic cerebral vasospasm. The preliminary results here indicate that Diltiazem might be especially effective for patients of Hunt-Hess grade II and III with CT grades of 2 and 3.