ADMINISTRATION OF NIMODIPINE

IN TRAUMATIC SUBARACHNOID HEMORRHAGE

M.Iman Indrasyah*, Selly Marisdina**
*) Resident, Department of Neurology, Faculty of Medicine Sriwijaya University/RS
Moh.Hoesin, Palembang
**) Lecturer, Department of Neurology, Faculty of Medicine Sriwijaya University/RS
Moh.Hoesin, Palembang
ABSTRACT
Background :
Traumatic Subarachnoid Hemorrhage (SAHt) is one of the complication that could happened
after a mild to severe head trauma. Incidence of SAHt varies from 14,3% to 33% of all head
trauma. Management of SAHt is different from common head trauma, which should prevent
further potential serious complication such as vasospasm that often cause death.
Case Report: A man, 32 years old, brought to the hospital with sudden altered consciousness after falling
from 4m height with the head in front. There was nausea and vomitting, but with no seizure. By the
clinical examination, we found that the level of consciousness was E3M5V4 on GCS Scale, and there
were meningeal signs specifically nuchal rigidity, Brudzinskis neck and symphyseal sign, and bilateral
Laseques and Kernigs Sign. We found no lateralization nor cranial nerve palsy. Clinical sign and
symptomps matched with grade III subarachnoid hemorrhage on Hunt and Hess Scale. CT brain images
show a hyperdense lesion fulfilled the left parietal sulcus, without the evidence of hydrocephalus. The
patient was treated with antifibrinolytic agent, parenteral analgetic, and neuroprotector. Calcium
antagonist (Nimodipine) was administered as soon as possible to this patient. It was based on the

vasospasm mechanism in head trauma thats associated with biochemical cascade which
disturbed calcium homeostasis, and could happend in 12 hours post trauma. The administration
of calcium antagonist was being continued for 21 days. During 3 weeks of hospital care, no sign
of vasospasm we found in this patient. We discharge the patient with clinical improvement, being
an outpatient.
Conclusion : Traumatic Subarachnoid Hemorrhage is a complication of head trauma which
should be identified immediately through clinical examination and additional testing. The
administration of calcium antagonist as soon as possible and be continued for 21 days give a
good clinical outcome.
Keywords: subarachnoid hemorrhage, head trauma, vasospasm