title: Magnesium infusion for vasospasm prophylaxis after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Despite the application of current standard therapies, vasospasm continues to result in death or major disability in patients treated for ruptured aneurysms. The authors investigated the effectiveness of continous MgSO4 infusion for vasospasm prophylaxis.
  
  
  METHODS
  Seventy-six adults (mean age 54.6 years; 71% women; 92% Caucasian) were included in this comparative matched-cohort study of patients with aneurysmal subarachnoid hemorrhage on the basis of computed tomography (CT) findings. Thirty-eight patients who received continuous MgSO4 infusion were matched for age, race, sex, treatment option, Fisher grade, and Hunt and Hess grade to 38 historical control individuals who did not receive MgSO4infusion. Twelve grams of MgSO4 in 500 ml normal saline was given intravenously daily for 12 days if the patient presented within 48 hours of aneurysm rupture. Vasospasm was diagnosed on the basis of digital substraction angiography, CT angiography, and transcranial Doppler ultrasonography, and evidence of neurological deterioration. Symptomatic vasospasm was present at a significantly lower frequency in patients who received MgSO4 infusion (18%) compared with patients who did not receive MgSO4 (42%) (p = 0.025). There was no significant difference in mortality rate at discharge (p = 0.328). A trend toward improved outcome as measured by the modifed Rankin Scale (p = 0.084), but not the Glasgow Outcome Scale (p = 1.0), was seen in the MgSO4 treated group.
  
  
  CONCLUSIONS
  Analysis of the results suggests that MgSO4 infusion may have a role in cerebral vasospasm prophylaxis if therapy is initiated within 48 hours of aneurysm rupture.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. stipplerm@upmc.edu
authors.forename: Martina
authors.initials: M
authors.lastname: Stippler
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crago
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kerr
authors.forename: Howard
authors.initials: H
authors.lastname: Yonas
authors.forename: Michael B
authors.initials: MB
authors.lastname: Horowitz
authors.forename: Amin
authors.initials: A
authors.lastname: Kassam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008278:Magnesium Sulfate / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D002121:Calcium Channel Blockers; D008278:Magnesium Sulfate