gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Long-term intravenous magnesium treatment for aneurysmal subarachnoid hemorrhage (SAH) – side effects and serum/CSF distribution

Meeting Abstract

  • Christian Stetter - Neurochirurgische Universitätsklinik Würzburg, Deutschland
  • Jörg Eriskat - Neurochirurgische Universitätsklinik Würzburg, Deutschland
  • Ekkehard Kunze - Neurochirurgische Universitätsklinik Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Neurochirurgische Universitätsklinik Würzburg, Deutschland
  • Thomas Westermaier - Neurochirurgische Universitätsklinik Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1844

DOI: 10.3205/10dgnc315, URN: urn:nbn:de:0183-10dgnc3151

Published: September 16, 2010

© 2010 Stetter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Increasing evidence suggests that SAH-patients benefit from intravenous magnesium treatment. We recently showed that magnesium sulfate can attenuate delayed vasospasm and increase the ischemic tolerance in case of cerebral vasospasm and perfusion deficits. However, a number of patients still developed vasospasm, infarction and delayed neurological deficits. This analysis covers the side effects and the serum/CSF-distribution during intravenous magnesium treatment.

Methods: A total of 107 patients was analyzed. 54 patients received magnesium, 53 served as controls. Serum electrolytes and creatinine were measured 3 times a day, CSF electrolytes and urine electrolytes were determined once a day. In all patients, invasive measurement of blood pressure, heart rate and central venous pressure was performed.

Results: While elevated serum magnesium levels were continuously maintained between 2.0 and 2.5 mmol/l in the magnesium-group (vs. 0.87±0.07 mmol/l in controls), CSF concentrations remained distinctly lower (1.52±0.19 mmol/l vs. 1.20±0.12 mmol/l in controls). In magnesium-treated patients, significant hypocalcemia and elevation in serum creatinine relative to control patients was observed. Mean arterial blood pressure and the amount of catecholamines administered to meet the individual blood pressure targets did not differ between the two groups. In magnesium-treated patients a significantly lower heart-rate was observed, but in no patient necessitated the exclusion from the study.

Conclusions: Intravenous magnesium-treatment proved to be safe and effective for patients suffering from aneurysmal SAH. Preexisting bradycardia and atrioventricular block of any degree should be an exclusion criteria for intravenous magnesium-treatment as well as an elevation of serum creatinine values. An elevation of magnesium serum concentrations above 2.5 mmol/l seems possible but should be performed under close cardiovascular surveillance. With respect to the potential hazards of very high serum-levels, a further elevation of CSF concentrations might be best performed by the intrathecal route.