Controlled study of nimodipine in treatment of patients with diffuse axonal injury

Objective: To determine the efficacy and safety of early intervention with nimodipine treatment in diffuse axonal injury. Methods: Based on the characteristic radiological signs and criteria for diffuse axonal injury (DAI), 89 patients with the diagnosis of DAI were enrolled in this randomized, double blind, placebo controlled trial. Results: Nimodipine proved to be safe and well tolerated. With TCD sonography we found that there was a higher incidence of cerebral vasospasm in this series ( 38.2 %). Overall, Nimodipine produced a better clinical result than placebo, but there was no statistically significant difference in favorable outcome at 3 months after injury (P= 0.11 ) between the two groups. A trend toward a favorable effect was suggested by the analyses in two small subgroups, either in the patients suffering from clinical Grade Ⅲ DAI (P= 0.04 ), or in those with the TCD evidence of cerebral vasospasm during clinical observation (P= 0.049 ). Conclusions: We postulate that a clinically valuable benefit is possible with nimodipine treatment in DAI patients. However, the effects on outcome should be verified by further controlled study.