Magnesium therapy within 48 hours of an aneurysmal subarachnoid hemorrhage: neuro-panacea.
Whereas advances in neurosurgical treatment and intensive care management improve the results from many of the devastating complications associated with aneurysmal subarachnoid hemorrhage, cerebral vasospasm remains a major cause of neurological morbidity and mortality. Experimental studies suggested that MgSO(4) inhibits excitatory amino acid release, blocks N-methyl-D-aspartate (NMDA) receptors and prevents calcium entry into the cell. Magnesium also increases red blood cell deformability. These changes may reduce the occurrence of cerebral vasospasm and minimize neuronal injury during episodes of cerebral vasospasm. Our group is currently hosting the intravenous magnesium sulfate to improve outcome after aneurysmal subarachnoid hemorrhage (IMASH) trial, which is a randomized, placebo-controlled, double-blinded, multicentered trial to evaluate the effect of magnesium sulfate infusion on the clinical outcome of patients with aneurysmal subarachnoid hemorrhage since 2002. The pilot result showed a trend towards decreased clinical vasospasm and better patient outcome. Magnesium sulfate infusion may prove to be an effective and inexpensive way to reduce the morbidity and mortality associated with aneurysmal subarachnoid hemorrhage, which is a major breakthrough in the current management.
Wong
George K C
GK
Division of Neurosurgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
Chan
Matthew T V
MT
Poon
Wai S
WS
Boet
Ronald
R
Gin
Tony
T
D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy*; D013997:Time Factors
D002121:Calcium Channel Blockers; D008278:Magnesium Sulfate