Effects of nimodipine on cerebral hemodynamics, and prognosis of diffuse axonal injury patients

OBJECTIVE: To evaluate the effects of nimodipine on hemodynamic state, vasospasm, and short time prognosis of diffuse axonal injury (DAI) patients.

METHODS: In a prospective, clinical trial double blind study, 40 DAI patients with Glasgow coma scale of 5-8 were selected and randomly divided into 2 equal groups. The first group was treated with 60 mg of nimodipine every 4 hours immediately after admission, and the control group did not receive this treatment. Mean blood flow velocity (MFV) and pulsatility index of both middle cerebral arteries were measured using transcranial Doppler on the 1st, 3rd, and 10th days of admission. Glasgow outcome scale was evaluated one month after admission. This study was performed from June 2003 to June 2004 at Imam Medical Center, Tabriz, Iran.

RESULTS: There were significant differences in MFV among the 3 transcranial Doppler, which demonstrated hemodynamic changes in these patients. Nimodipine did not have any significant difference on MFV between the treatment and control groups. In the nimodipine group, 45% had good prognosis (30% in the control group) and nobody had vasospasm on the 10th day Doppler study (15% in the control group), although it did not show any statistical significant difference between them.

CONCLUSION: Nimodipine improved the prognosis and decreased vasospasm, however, there was no statistical difference. Therefore, we suggest further studies in a larger number of DAI patients.