title: Initial clinical experience of vasodilatory effect of intra-cisternal infusion of magnesium sulfate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: The vasodilatory effect of intra-cisternal infusion of magnesium sulfate solution was evaluated in 10 patients with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) who underwent early clipping surgery. Cisternal drainage was installed in the prepontine and/or sylvian fissures. Carotid angiography was performed immediately after the onset of symptomatic vasospasm, then intra-cisternal infusion of 15 mmol/l magnesium sulfate in Ringer solution was started at 20 ml/hr and continued until day 14. Irrigation was performed from the cisternal tube (inlet) to the spinal drainage (outlet). The cerebrospinal fluid magnesium ion concentration (1.2 +/- 0.2 mEq/l) significantly increased after the infusion therapy (6.0 +/- 1.7 mEq/l, p < 0.001). Repeat angiography showed vasodilatory effect on the spastic cerebral arteries at 3 hours after the infusion, especially in the arteries near to the site of cisternal drainage placement. The magnesium infusion also caused decreased mean arterial blood velocity in the spastic arteries in 6 of the 7 measured patients (162 +/- 38 cm/sec to 114 +/- 42 cm/sec, p < 0.001). Finally, 5 of the 10 patients achieved good recovery, 1 patient had moderate disability, 1 patient became severely disabled due to meningitis, and 3 patients were vegetative or dead, due to failure of magnesium irrigation in 1 patient and advanced age in the other 2 (more than 80 years old). This preliminary study indicates that intra-cisternal infusion of magnesium sulfate solution has vasodilatory effect on the spastic cerebral arteries after aneurysmal SAH.
authors.affiliation: Department of Neurosurgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, Japan. kmori@med-juntendo.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
authors.forename: Takuji
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nakao
authors.forename: Hideo
authors.initials: H
authors.lastname: Osada
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Hara
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Oyama
authors.forename: Takanori
authors.initials: T
authors.lastname: Esaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007276:Injections, Intraventricular / Q000009:adverse effects / Q000379:methods; D008274:Magnesium / Q000134:cerebrospinal fluid; D008278:Magnesium Sulfate / Q000008:administration & dosage*; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013346:Subarachnoid Space / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D008278:Magnesium Sulfate; D008274:Magnesium