Document Detail


Initial clinical experience of vasodilatory effect of intra-cisternal infusion of magnesium sulfate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  19398856     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The vasodilatory effect of intra-cisternal infusion of magnesium sulfate solution was evaluated in 10 patients with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) who underwent early clipping surgery. Cisternal drainage was installed in the prepontine and/or sylvian fissures. Carotid angiography was performed immediately after the onset of symptomatic vasospasm, then intra-cisternal infusion of 15 mmol/l magnesium sulfate in Ringer solution was started at 20 ml/hr and continued until day 14. Irrigation was performed from the cisternal tube (inlet) to the spinal drainage (outlet). The cerebrospinal fluid magnesium ion concentration (1.2 +/- 0.2 mEq/l) significantly increased after the infusion therapy (6.0 +/- 1.7 mEq/l, p < 0.001). Repeat angiography showed vasodilatory effect on the spastic cerebral arteries at 3 hours after the infusion, especially in the arteries near to the site of cisternal drainage placement. The magnesium infusion also caused decreased mean arterial blood velocity in the spastic arteries in 6 of the 7 measured patients (162 +/- 38 cm/sec to 114 +/- 42 cm/sec, p < 0.001). Finally, 5 of the 10 patients achieved good recovery, 1 patient had moderate disability, 1 patient became severely disabled due to meningitis, and 3 patients were vegetative or dead, due to failure of magnesium irrigation in 1 patient and advanced age in the other 2 (more than 80 years old). This preliminary study indicates that intra-cisternal infusion of magnesium sulfate solution has vasodilatory effect on the spastic cerebral arteries after aneurysmal SAH.
Authors:
Kentaro Mori; Takuji Yamamoto; Yasuaki Nakao; Hideo Osada; Yasukazu Hara; Kazutaka Oyama; Takanori Esaki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurologia medico-chirurgica     Volume:  49     ISSN:  1349-8029     ISO Abbreviation:  Neurol. Med. Chir. (Tokyo)     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-28     Completed Date:  2009-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400775     Medline TA:  Neurol Med Chir (Tokyo)     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  139-44; discussion 144-5     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, Japan. kmori@med-juntendo.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Pressure / drug effects,  physiology
Calcium Channel Blockers / administration & dosage
Cerebral Angiography
Cerebral Arteries / drug effects*,  physiopathology
Female
Humans
Injections, Intraventricular / adverse effects,  methods
Magnesium / cerebrospinal fluid
Magnesium Sulfate / administration & dosage*
Male
Meningitis / etiology
Middle Aged
Postoperative Complications / etiology
Subarachnoid Hemorrhage / complications*
Subarachnoid Space / drug effects,  physiology
Treatment Outcome
Vasodilation / drug effects,  physiology
Vasodilator Agents / administration & dosage
Vasospasm, Intracranial / drug therapy*,  etiology,  physiopathology
Chemical
Reg. No./Substance:
0/Calcium Channel Blockers; 0/Vasodilator Agents; 7439-95-4/Magnesium; 7487-88-9/Magnesium Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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