[Effect of calcium antagonist (diltiazem) on symptomatic cerebral vasospasm].

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.