Artikel
Effects of intravenous magnesium sulfate in the treatment of aneurysmatic subarachnoid hemorrhage – a randomized study
Magnesiumsulfat in der Behandlung aneurysmatischer Subarachnoidalblutungen – eine randomisierte Studie
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Veröffentlicht: | 11. April 2007 |
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Objective: Secondary ischemic deficits may cause major disability or death in patients with aneurysmatic subarachnoid hemorrhage. Calcium antagonists have long been subject of clinical and experimental studies regarding neuroprotection in cerebral vascular insults. Magnesium has shown beneficial effects in various experimental studies of cerebral ischemia. This study was performed to assess the protective efficacy of intravenous magnesium in subarachnoid hemorrhage.
Methods: 122 patients were enrolled in the study and were randomized to receive magnesium sulfate (therapeutic serum level 2.0 – 2.5 mmol/l) for at least 10 days or to serve as controls. All patients were treated by prophylactic hyperdynamic therapy, received transcranial Doppler sonography twice a day, and regular CT/Perfusion-CT. When signs of cerebral vasospasm were present, patients underwent cerebral angiography. Angioplasty was performed if spasms were accessible. Outcome parameters were secondary cerebral infarction and GOS after 6 months.
Results: 18 patients had to be excluded from the study. The use of magnesium in the dose used in this study did not cause major drug-related complications. In the magnesium group (n=52) 5 patients died in the course of treatment compared to 10 patients in the control group (n=53). In the magnesium group 62% (32 patients) reached an outcome of GOS 4 and 5 after 6 months compared to 51% (27 patients) in the control group. The incidence of vasospasm as determined by transcranial Doppler sonography and/or Perfusion-CT did not markedly differ between the two groups. However, the incidence of secondary cerebral infarction was lower in the magnesium group.
Conclusions: The use of intravenous magnesium sulfate – even in high doses – is safe and well controllable. Magnesium did not markedly inhibit the appearance of cerebral vasospasm. However, it seems to exert a neuroprotective effect in situations of compromised cerebral perfusion after aneurysmatic subarachnoid hemorrhage.