BACKGROUND

In spite of major recent advances in the treatment of aneurysmal subarachnoid hemorrhage (SAH), management of cerebral vasospasm and its consequences still remain a formidable clinical challenge. Magnesium may exhibit a range of vascular and neuronal actions that may ameliorate ischemic central nervous system insults.

OBJECTIVES

(1) To determine whether i ntravenous magnesium therapy in addition to standard care can improve functional outcome in patients with aneu rysmal SAH. (2) To determine whether intravenous magnesium therapy in addition to standard care can reduce the frequency of symptomatic vasospasm.

METHODOLOGY

Medline, Cochrane, Ovid, Stroke Group Trial Register and Herdin databases were searched to identify all randomized controlled trials on the use of intravenous magnesium therapy in addition to standard care versus standard care alone in patients with aneurysmal SAH. The studies were analyzed using the Review Manager 4.2 software. An estimate of the treatment effect across trials were measured using relative risks (with a 95% confidence interval) and were pooled using random effects.

RESULTS

Three studies involving 379 patients were included. Overall, the relative risk of intravenous magnesium therapy for poor outcome was 0.75 (95% Cl, 0.57 - 1 .0). Although there was a trend to favor the treatment group, it did not reach statistical significance. The risk of intravenous magnesi um therapy on the occurrence of symptomatic vasospasm was significantly reduced, with a RR of 0.66 (95% Cl, 0.45-0.96).

CONCLUSION

I ntravenous magnesi um therapy as adj unct to standard care in patients with aneurysmal SAH shows a trend favoring treatment with a significant reduction in symptomatic vasospasm but not enough evidence to support its effect on improving over-all functional outcome.

Human ; Subarachnoid Hemorrhage, Aneurysmal ; Subarachnoid Hemorrhage ; Cerebral Vasospasm ; Vasospasm, Intracranial

Purpose : The purpose of this study was to analyze the incidence if subarachnoid hemorrhage (SAH) in residents of Honjo City and its vicinity in northen Japan with a total population of 123,000 during the 8-year period from 1995 through 2002, and to evaluated the overall management outcome of the patients with SAH. Methods : All patients suspected of having SAH are referred to our hospital, which plays a crucial role as a “core” hospital in the region. Computed tomography (CT) scan was indicated for all the patients to verify the occurrence of SAH, and subsequently three dimensional (3D) CT angiography and/or catheter angiography were performed to confirm rupture of aneurysms. Results : During the period under review a total of 327 patients were diagnosed as having aneurysmal SAH, and ruptured aneurysms were confirmed in 276 cases (84%). The cruse annual incidence was 33.0 per 100,000 population for all ages during the entire 8-year period. However, the annual incidence has gradually decreased in contrast to an increasing number of operations for unruptured aneurysms performed during the same period. The age ranged from 21 to 92 years with the mean age of 64.5, and the incidence reached a peak in the 70-79 age group. Women far exceeded men in the incidence at the ratio of 1.8 to 1. The high grade patients with severe SAH as evaluated as grade 4 and 5 according to Hunt & Kosnik’s classification consisted of 45%, and 50% of this group were the patients 70 and older. Overall management outcome was assessed 6 months after the onset of SAH with the use of Glasgow Outcome Scale, and favorable outcome such as good recovery and moderate disability was obtained in 42% of the total 327 patients and death occurred in 39%. Conclusion : The high incidence of SAH was confirmed, and it was also noted that the number of elderly patients with severe SAH has increased in this region. Preventive treatment for unruptured aneurysms may be one clue to the solution of this devastating medical problem.
incidence of cases ; X-Ray Computed Tomography ; Japan ; Subarachnoid Hemorrhage, Aneurysmal ; Hospitals