A Look at Magnesium in Subarachnoid Hemorrhage
A Look at Magnesium in Subarachnoid Hemorrhage
Ladies and gentlemen, I am Christoph Diener, a neurologist from Germany. My topic today is the treatment of subarachnoid hemorrhage. One of the major complications of subarachnoid hemorrhage is delayed cerebral ischemia due to vasospasm. In animal experiments, magnesium is able to prevent vasospasm and also is neuroprotective.
A phase 3 study was conducted in The Netherlands, and patients who had an acute subarachnoid hemorrhage were randomly assigned to a placebo group or to a group that was treated with intravenous magnesium. The endpoint of the study was poor outcome, which is modified Rankin Scale 4-5 at 3 months or death.
The study included a total of 1204 patients. A poor outcome was seen in 158 patients (26%) from the magnesium group and 151 patients (25%) in the placebo group. So, there was no difference in outcome between patients who were treated with magnesium and those given placebo. The investigators also performed a meta-analysis of all the trials that were done until recently, and the meta-analysis also did not show any benefit of intravenous magnesium in patients with subarachnoid hemorrhage.
So, unfortunately, beyond nimodipine, which has proven efficacy in preventing vasospasm and delayed ischemia, at present we have no other treatment option. In some patients, local catheter-based treatment with papaverine is an option.
Ladies and gentlemen, I am Christoph Diener, a neurologist from Essen, Germany. Thank you very much for listening.
Ladies and gentlemen, I am Christoph Diener, a neurologist from Germany. My topic today is the treatment of subarachnoid hemorrhage. One of the major complications of subarachnoid hemorrhage is delayed cerebral ischemia due to vasospasm. In animal experiments, magnesium is able to prevent vasospasm and also is neuroprotective.
A phase 3 study was conducted in The Netherlands, and patients who had an acute subarachnoid hemorrhage were randomly assigned to a placebo group or to a group that was treated with intravenous magnesium. The endpoint of the study was poor outcome, which is modified Rankin Scale 4-5 at 3 months or death.
The study included a total of 1204 patients. A poor outcome was seen in 158 patients (26%) from the magnesium group and 151 patients (25%) in the placebo group. So, there was no difference in outcome between patients who were treated with magnesium and those given placebo. The investigators also performed a meta-analysis of all the trials that were done until recently, and the meta-analysis also did not show any benefit of intravenous magnesium in patients with subarachnoid hemorrhage.
So, unfortunately, beyond nimodipine, which has proven efficacy in preventing vasospasm and delayed ischemia, at present we have no other treatment option. In some patients, local catheter-based treatment with papaverine is an option.
Ladies and gentlemen, I am Christoph Diener, a neurologist from Essen, Germany. Thank you very much for listening.
