Thursday June 14, 2007
Intravenous Magnesium in Subarachnoid Hemorrhage (vs Nimodipine)

The prophylactic use of nimodipine, a calcium channel blocker, in aneurysmal subarachnoid hemorrhage is a standard of practice to reduce the risk of ischemic brain injury. Recently one study published in 'Neurosurgery' 1 to see if magnesium being a calcium antagonist, can have same effect as it also promotes dilatation of cerebral arteries, and relatively has a high safety margin.

104 patients with aneurysmal subarachnoid hemorrhage were randomized to receive either magnesium sulfate (n=53) (loading 10 mg/kg followed by 30 mg/kg daily) or nimodipine (n=51) (48 mg/d) intravenously until at least postoperative Day 7.

Primary outcome parameters set were

• incidence of clinical vasospasm and
• cerebral infarction

Secondary outcome measures targeted were

• incidence of transcranial Doppler/angiographic vasospasm,
• the neuronal markers (neuron-specific enolase, S-100), and
• the patients' Glasgow Outcome Scale scores at discharge and after 1 year.

In the magnesium group , 15% patients experienced clinical vasospasm and 38% experienced transcranial Doppler/angiographic vasospasm compared with 27% and 33% patients in the nimodipine group.

Overall, the rate of infarction attributable to vasospasm was virtually the same (19 versus 22%). There was no difference in outcome between groups.

Study concluded that the efficacy of magnesium in preventing delayed ischemic neurological deficits in patients with aneurysmal subarachnoid hemorrhage seems to be comparable with that of nimodipine.


Reference: clickable
Intravenous Magnesium versus Nimodipine in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage: A Randomized Study - Neurosurgery. 58(6):1054-1065, June 2006.