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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Intravenous magnesium sulphate in the treatment of vasospasm after aneurysmal SAH

Meeting Abstract

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  • T. Westermaier - Neurochirurgische Klinik, Universitätsklinikum Würzburg
  • C. Stetter - Neurochirurgische Klinik, Universitätsklinikum Würzburg
  • J. Eriskat - Neurochirurgische Klinik, Universitätsklinikum Würzburg
  • E. Kunze - Neurochirurgische Klinik, Universitätsklinikum Würzburg
  • K. Roosen - Neurochirurgische Klinik, Universitätsklinikum Würzburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.02-09

doi: 10.3205/09dgnc117, urn:nbn:de:0183-09dgnc1175

Published: May 20, 2009

© 2009 Westermaier 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: Secondary ischemic deficits due to cerebral vasospasm are still the major cause of in-hospital mortality and morbidity after aneurysmal SAH. 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 potential of intravenous magnesium in subarachnoid haemorrhage.

Methods: 107 patients were enrolled in the study and were randomized to receive intravenous magnesium sulphate (target serum level 2.0–2.5 mmol/l) for at least 10 days (n=54) or serve as controls (n=53). All patients were treated by prophylactic hyperdynamic therapy. Transcranial Doppler sonography was performed twice daily, when signs of cerebral vasospasm were present, angiography was performed with angioplasty, if spasms were accessible.

Results: The use of magnesium in the dose used in this study did not cause major drug-related complications. In the magnesium group 9 patients showed signs of clinical vasospasm compared to 15 patients in the control group. 36 patients in the magnesium group had TCD-detected and/or angiographic vasospasm compared to 45 patients in the control group. One of 9 patients in the magnesium group and 7 of 15 patients in the control group with clinical vasospasm developed secondary infarction. 10 of 36 patients in the magnesium group and 26 of 45 patients in the control group with TCD-detected and/or angiographic vasospasm developed secondary infarction.

Conclusions: The prophylactic use of intravenous magnesium sulphate – even in high doses – is safe and well controllable. Continuous infusion of magnesium sulphate did not only markedly inhibit the appearance of cerebral vasospasm. It seems to exert a neuroprotective effect in case of cerebral vasospasm.