title: Prophylactic magnesium for improving neurologic outcome after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis.
abstract: OBJECTIVE
  Neurologic disability is common after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to systematically review the prophylactic use of magnesium to improve neurologic outcomes in these patients.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials to June 2012 for randomized and quasi-randomized controlled trials of intravenous magnesium in adults after aSAH, given before radiologic vasospasm or delayed cerebral ischemia (DCI) and compared with any control group. Two reviewers independently extracted data on study population, interventions, and outcomes (good neurologic outcome [primary outcome], cerebral infarction, DCI, radiographic vasospasm, mortality, adverse events). Analyses used random-effects models.
  
  
  RESULTS
  Of 702 citations, 13 trials (n = 2401) met the selection criteria. Meta-analyses showed that magnesium did not increase the probability of good neurologic outcome (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97-1.07; P = .49; 12 trials, n = 2345) or decrease the risks of cerebral infarction (RR, 0.69; 95% CI, 0.46-1.05; P = .08; 5 trials, n = 572), radiographic vasospasm (RR, 0.86; 95% CI, 0.71-1.04; P = .13; 7 trials, n = 438), or mortality (RR, 0.98; 95% CI, 0.80-1.20; P = .86; 11 trials, n = 2092). Magnesium did reduce the risk of DCI (RR, 0.73; 95% CI, 0.56-0.96; P = .02; 10 trials, n = 1095). Data on adverse events were generally sparse.
  
  
  CONCLUSIONS
  Despite decreasing the incidence of DCI in patients with aSAH, prophylactic intravenous magnesium does not improve neurologic outcome or decrease cerebral infarction, radiographic vasospasm, or mortality.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ontario, Canada M5T 2S8.
authors.forename: Eyal
authors.initials: E
authors.lastname: Golan
authors.forename: Daniela N
authors.initials: DN
authors.lastname: Vasquez
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
mesh_terms: D002545:Brain Ischemia / Q000517:prevention & control; D002986:Clinical Trials as Topic; D006801:Humans; D008274:Magnesium / Q000008:administration & dosage / Q000627:therapeutic use*; D009422:Nervous System Diseases / Q000503:physiopathology / Q000517:prevention & control; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000517:prevention & control
chemical_list: D008274:Magnesium