Poor-grade subarachnoid hemorrhage patients: the use of nimodipine and other optional treatments.

The use of calcium antagonists has been advocated as decreasing morbidity and mortality in patients with subarachnoid hemorrhage (SAH) following aneurysm rupture. Results reported from open or placebo-controlled studies show a wide variation with regard to outcome. The immediate clipping of an aneurysm as soon as diagnosed accompanied or not by removal of expansive hematomas, drainage of CSF obstructions, decompressive craniectomy and the employment of individual variation in the critical intensive care schema, may eventually influence the outcome of patients in a bad clinical condition (Hunt and Hess Grade IV and V). The aim of this paper is to analyze which patients should profit from a differential treatment on a literature review and own experience-based data.