Characterizing the use of intrathecal nicardipine for post traumatic cerebral vasospasm and treatment-related complications. 

Post traumatic cerebral vasospasm (PTV) is a significant cause of secondary neurologic injury after traumatic brain injury (TBI) and is associated with worse outcomes. There is limited data to guide treatment of PTV. Intrathecal nicardipine (ITn) was shown to improve outcomes and reduce delayed cerebral ischemia in non-traumatic subarachnoid hemorrhage (SAH) patients, but traumatic mechanisms were not well studied. In this retrospective study, we characterize the use of ITn for PTV at a high-volume trauma center.  

We reviewed all TBI admissions at a high-volume trauma center over a 10-year period. Patients ≥18 years of age requiring external ventricular drain (EVD) placement were included. We collected data regarding injury severity, length of stay, rationale, and timing for initiation of ITn, dosing, frequency and treatment-related complications. 

Seven patients with severe TBI received ITn for radiographic vasospasm (VSP) on surveillance imaging. The average duration of treatment was 6 days. ITn was stopped given radiographic improvement (4), pre-defined decision for 48 hours of treatment (1), after DSA revealed no VSP (1) or identification of ventriculitis (1). Three patients had delayed cerebral ischemia on imaging; however, these were noted before the initiation of ITn. Two patients developed ventriculitis and one patient had brief, elevated intracranial pressure spikes with ITn.