Deans' stroke musings: Patients With Haemorrhagic Stroke Fare Better if They Tolerate Full Course of Nimodipine

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 27, 2016

Patients With Haemorrhagic Stroke Fare Better if They Tolerate Full Course of Nimodipine

I'm sure your doctor has warned you about nimodipine side effects.

mild dizziness;
flushing (redness, warmth, or tingling feeling);
headache;
nausea, constipation; or.
sweating.

http://dgnews.docguide.com/patients-haemorrhagic-stroke-fare-better-if-they-tolerate-full-course-nimodipine?
Patients hospitalised with aneurysmal subarachnoid haemorrhage who can tolerate 90% of their scheduled doses of nimodipine have a better chance of being discharged home than patients who have lower compliance with the agent, according to results of a retrospective study presented at the 141st Annual Meeting of the American Neurological Association (ANA).
“Nimodipine compliance of 90.1% or higher was most predictive of a good outcome, while multivariate logistic regression reveals that older age, World Federation of Neurological Surgeons (WFNS) grade 3 or greater, and missing 1 or more nimodipine doses are associated with worse clinical outcomes,” reported lead author Aaron Wessell, MD, University of Maryland School of Medicine, Baltimore, Maryland, speaking at a poster presentation here on October 16.
Dr. Wessell and colleagues analysed the records of 118 consecutive patients with aneurysmal subarachnoid haemorrhage, all of whom were treated with the Maryland Low-Dose IV Heparin Infusion Protocol between July 2008 and July 2015. In all, 53 patients were discharged home -- and 83% of those received at least 90% of the scheduled nimodipine doses. On the other hand, 31 of 65 patients (48%) were discharged to rehabilitation facilities or died in hospital (P < .001).
High compliance was reported among 75 patients; low compliance was reported in 43 patients. Patients who had lower compliance were about 6 years older on average: 53.56 years compared with 59.60 years (P = .011). Those with a higher-grade haemorrhage also were more likely to have low compliance -- with an average of WFNS grade 2 for those who were compliant compared with grade 4 for patients who were unable to receive the full dosing (P < .001).
Halving the dose of nimodipine and administering it at 30 mg every 2 hours did not appear to have a negative effect on outcome. Patients were treated with nimodipine for as long as 21 days.
Dr. Wessell noted that nimodipine is the only pharmacological agent that has shown consistency in randomised, placebo-controlled trials to improve outcomes in aneurysmal subarachnoid haemorrhage. “Unfortunately, a significant percentage of patients admitted with aneurysmal subarachnoid haemorrhage demonstrate sensitivity to nimodipine’s hypotensive effect,” he noted.
The average age of patients in this study was 55.76 years; about 65% of the patients were female. In all, about 62% of patients had been diagnosed with hypertension; 54% had a history of tobacco use; and 74% were diagnosed with symptomatic hydrocephalus.
[Presentation title: High Compliance with Scheduled Nimodipine Is Associated with Better Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Co-Treated with Heparin Infusion. Abstract 218]