Safety of Early Discharge and Abbreviated Nimodipine Course in Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage

Authors

• Patrick R. Toyota
• Alexander D. Rebchuk
• Michael A. Rizzuto, Thomas Jefferson UniversityFollow
• Hugh McHugh
• Kelsey Cruz
• Charles S. Haw
• Gary J. Redekop
• Peter Gooderham

Document Type

Article

Publication Date

7-23-2026

Comments

This article is the author’s final published version in Journal of Clinical Neuroscience, Volume 153, 2026, Article number 112214.

The published version is available at https://doi.org/10.1016/j.jocn.2026.112214. Copyright © 2026 The Author(s).

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) remains a devastating cerebrovascular emergency associated with substantial morbidity and mortality. Current guidelines recommend 14-21 days of inpatient monitoring and a 21-day course of nimodipine following aSAH. This retrospective study evaluates early outcomes early discharge (≤14 days post-ictus) and an abbreviated nimodipine course in highly selected patients with good-grade aSAH managed under a standardized institutional protocol. Consecutive patients enrolled in the Vancouver Ruptured Aneurysm Database (VRAD) at Vancouver General Hospital between 2022 and 2025 were included. Inclusion criteria were good-grade aSAH (WFNS Grade I-III) and discharge home within 14 days of ictus. The primary outcome was re-presentation to emergency care within 30 days of discharge; secondary outcomes included hospital readmission and need for additional treatment. Of 333 total patients in VRAD, 49 patients met inclusion criteria. All patients received ≤ 14 days of nimodipine therapy. Forty-two patients (85.7%) were WFNS Grade I on presentation, 3 (6.1%) were WFNS Grade II, and 4 (8.2%) were WFNS Grade III. Radiographic vasospasm was reported in 18 cases (36.7%). No patients developed DCI or clinical vasospasm. Four patients (8.2%) re-presented to emergency care within 30 days of discharge, and only one patient (2%) required hospital re-admission within 30 days. While radiographic vasospasm was seen in over one third of patients, none developed clinical sequelae, supporting the premise that radiographic vasospasm alone may be insufficient to preclude early discharge in select good-grade patients.

Recommended Citation

Toyota, Patrick R.; Rebchuk, Alexander D.; Rizzuto, Michael A.; McHugh, Hugh; Cruz, Kelsey; Haw, Charles S.; Redekop, Gary J.; and Gooderham, Peter, "Safety of Early Discharge and Abbreviated Nimodipine Course in Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage" (2026). Department of Neurosurgery Faculty Papers. Paper 315.
https://jdc.jefferson.edu/neurosurgeryfp/315

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

42492195

Language

English