Early Intravenous Magnesium Sulfate and Its Impact on Cerebral Vasospasm as well as Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Retrospective Matched Case-Control Analysis

Abstract

Magnesium sulfate (MgSO4) is a potential neuroprotective agent for patients with aneurysmal subarachnoid hemorrhage (aSAH). We analysed the effect of early application of intraoperative intravenous magnesium sulfate (MgSO4) and compared the rate of cerebral vasospasm (CV), delayed cerebral ischemia (DCI) and neurological outcome in two patient cohorts. A retrospective matched-pair analysis from patients of a single center in Germany was performed without (group A) and with (group B) MgSO4 application <24 hrs after diagnosis. Pairs were matched according to the known risk factors for DCI and CV (age, Fisher grade, smoking, severity of SAH). Incidence of CV, DCI, and neurological outcome using the modified Rankin Scale (mRS) 3 and 12 months after SAH were recorded. 196 patients fulfilled the inclusion criteria. After risk stratification, 48 patients were included in the final analysis (mean±SD age 54.2±8.1yrs, 30 f, 18 m) and were assigned to group A (n=24) or group B (n=24). CV occurred less frequently in group B (33%) than in A (46%). Likewise, DCI was present in 13% (group B) as compared to 42% (group A). After 12 months, 22 patients of group B had a favorable functional outcome (mRS 0 to 3) compared to 15 of group A. In this study, the incidence of CV and DCI was lower in patients receiving intravenous MgSO4 within 24 hrs after aneurysmal SAH onset. Favorable functional outcome was more likely in the magnesium group after 12 months of follow-up.