| Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 11883835 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECT: Vasospasm remains a significant source of neurological morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH), despite advances in current medical, surgical, and endovascular therapies. Magnesium sulfate therapy has been demonstrated to be both safe and effective in preventing neurological complications in obstetrical patients with eclampsia. Evidence obtained using experimental models of brain injury, cerebral ischemia, and SAH indicate that Mg may also have a role as a neuroprotective agent. The authors hypothesize that MgSO4 therapy is safe, feasible, and has a beneficial effect on vasospasm and, ultimately, on neurological outcome following aneurysmal SAH. METHODS: A prospective randomized single-blind clinical trial of high-dose MgSO4 therapy following aneurysmal SAH (Hunt and Hess Grades II-IV) was performed in 40 patients, who were enrolled within 72 hours following SAH and given intravenous MgSO4 or control solution for 10 days. Serum Mg++ levels were maintained in the 4 to 5.5 mg/dl range throughout the treatment period. Clinical management principles were the same between groups (including early use of surgery or endovascular treatment, followed by aggressive vasospasm prophylaxis and treatment). Daily transcranial Doppler (TCD) ultrasonographic recordings were obtained, and clinical outcomes were measured using the Glasgow Outcome Scale (GOS). The patients' GOS scores and the TCD recordings were analyzed using the independent t-test. Forty patients were enrolled in the study: 20 (15 female and five male patients) received treatment and 20 (11 female and nine male patients) comprised a control group. The mean ages of the patients in these groups were 46 and 51, respectively, and the mean clinical Hunt and Hess grades were 2.6 +/- 0.68 in the MgSO4 treatment group and 2.3 +/- 0.73 in the control group (mean +/- standard deviation [SD], p = 0.87). Fisher grades were similar in both groups. Mean middle cerebral artery velocities were 93 +/- 27 cm/second in MgSO4-treated patients and 102 +/- 34 cm/second in the control group (mean +/- SD, p = 0.41). Symptomatic vasospasm, confirmed by angiography, occurred in six of 20 patients receiving MgSO4 and in five of 16 patients receiving placebo. Mean GOS scores were 3.8 +/- 1.6 and 3.6 +/- 1.5 (mean +/- SD, p = 0.74) in the treatment and control groups, respectively. Significant adverse effects from treatment with MgSO4 did not occur. CONCLUSIONS: Administration of high-dose MgSO4 following aneurysmal SAH is safe, and steady Mg++ levels in the range of 4 to 5.5 mg/dl are easily maintained. This treatment does not interfere with neurological assessment, administration of anesthesia during surgery, or other aspects of clinical care. We observed a trend in which a higher percentage of patients obtained GOS scores of 4 or 5 in the group treated with MgSO4, but the trend did not reach a statistically significant level. A larger study is needed to evaluate this trend further. |
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Authors:
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Richard S Veyna; Donald Seyfried; Don G Burke; Chris Zimmerman; Mark Mlynarek; Victoria Nichols; Anna Marrocco; Ajith J Thomas; Panayiotis D Mitsias; Ghiaus M Malik |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of neurosurgery Volume: 96 ISSN: 0022-3085 ISO Abbreviation: J. Neurosurg. Publication Date: 2002 Mar |
Date Detail:
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Created Date: 2002-03-08 Completed Date: 2002-03-29 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: United States |
Other Details:
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Languages: eng Pagination: 510-4 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurosurgery, Henry Ford Hospital, Detroit 48202, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aneurysm, Ruptured
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drug therapy*,
ultrasonography Blood Flow Velocity / drug effects Cerebral Angiography Dose-Response Relationship, Drug Female Glasgow Outcome Scale Humans Infusions, Intravenous Intracranial Aneurysm / drug therapy*, ultrasonography Magnesium Sulfate / adverse effects, therapeutic use* Male Middle Aged Prospective Studies Single-Blind Method Subarachnoid Hemorrhage / drug therapy*, ultrasonography Ultrasonography, Doppler, Transcranial Vasospasm, Intracranial / drug therapy*, ultrasonography |
| Chemical | |
Reg. No./Substance:
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7487-88-9/Magnesium Sulfate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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