on March 24, 2005
Published online before print March 24, 2005, doi: 10.1161/01.STR.0000160801.96998.57
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on December 30, 2004
* To whom correspondence should be addressed. E-mail: w.m.vandenbergh{at}neuro.azu.nl.
Background and Purpose--Magnesium reverses cerebral vasospasm and reduces infarct volume after experimental subarachnoid hemorrhage (SAH) in rats. We aimed to assess whether magnesium reduces the frequency of delayed cerebral ischemia (DCI) in patients with aneurysmal SAH. Methods--Patients were randomized within 4 days after SAH. Magnesium sulfate therapy consisted of a continuous intravenous dose of 64 mmol/L per day, to be started within 4 days after SAH and continued until 14 days after occlusion of the aneurysm. The primary outcome DCI (defined as the occurrence of a new hypodense lesion on computed tomography compatible with clinical features of DCI) was analyzed according to the "on-treatment" principle. For the secondary outcome measures "poor outcome" (Rankin >3) and "excellent outcome" (Rankin 0), we used the "intention-to-treat" principle. Results--A total of 283 patients were randomized. Magnesium treatment reduced the risk of DCI by 34% (hazard ratio, 0.66; 95% CI, 0.38 to 1.14). After 3 months, the risk reduction for poor outcome was 23% (risk ratio, 0.77; 95% CI, 0.54 to 1.09). At that time, 18 patients in the treatment group and 6 in the placebo group had an excellent outcome (risk ratio, 3.4; 95% CI, 1.3 to 8.9). Conclusions--This study suggests that magnesium reduces DCI and subsequent poor outcome, but the results are not yet definitive. A next step should be a phase III trial to confirm the beneficial effect of magnesium therapy, with poor outcome as primary outcome.
Revised on December 30, 2004
Accepted on January 14, 2005
Magnesium Sulfate in Aneurysmal Subarachnoid Hemorrhage. A Randomized Controlled Trial
Walter M. van den Bergh* on behalf of the MASH Study Group
Key words: ischemia • magnesium • randomized controlled trials • subarachnoid hemorrhage
This article has been cited by other articles:
 |
|
 |
|
  B. P. Meloni, K. Campbell, H. Zhu, and N. W. Knuckey In Search of Clinical Neuroprotection After Brain Ischemia: The Case for Mild Hypothermia (35{degrees}C) and Magnesium Stroke, June 1, 2009; 40(6): 2236 - 2240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Bederson, E. S. Connolly Jr, H. H. Batjer, R. G. Dacey, J. E. Dion, M. N. Diringer, J. E. Duldner Jr, R. E. Harbaugh, A. B. Patel, and R. H. Rosenwasser Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association Stroke, March 1, 2009; 40(3): 994 - 1025. [Full Text] [PDF]
|
|
|
|
|
|
R. L. Macdonald, N. F. Kassell, S. Mayer, D. Ruefenacht, P. Schmiedek, S. Weidauer, A. Frey, S. Roux, A. Pasqualin, and on behalf of the CONSCIOUS-1 Investigators Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1): Randomized, Double-Blind, Placebo-Controlled Phase 2 Dose-Finding Trial Stroke, November 1, 2008; 39(11): 3015 - 3021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Dorhout Mees, M. J.A. Luitse, W. M. van den Bergh, and G. J.E. Rinkel Fever After Aneurysmal Subarachnoid Hemorrhage: Relation With Extent of Hydrocephalus and Amount of Extravasated Blood Stroke, July 1, 2008; 39(7): 2141 - 2143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.S. Bartynski Posterior Reversible Encephalopathy Syndrome, Part 2: Controversies Surrounding Pathophysiology of Vasogenic Edema AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1043 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Zemke, M. U Farooq, A. Mohammed Yahia, and A. Majid Delayed ischemia after subarachnoid hemorrhage: result of vasospasm alone or a broader vasculopathy? Vascular Medicine, August 1, 2007; 12(3): 243 - 249. [Abstract] [PDF]
|
|
|
|
 |
|
 S. M Dorhout Mees, W. M van den Bergh, A. Algra, and G. J E Rinkel Achieved serum magnesium concentrations and occurrence of delayed cerebral ischaemia and poor outcome in aneurysmal subarachnoid haemorrhage J. Neurol. Neurosurg. Psychiatry, July 1, 2007; 78(7): 729 - 731. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T.V. Chan, K. C. Choi, G. K.C. Wong, and W. S. Poon Interaction Between Magnesium Sulfate and Acetylsalicylic Acid in the MASH Trial Stroke, May 1, 2007; 38(5): e14 - e14. [Full Text] [PDF]
|
|
|
|
|
|
W. M. van den Bergh and on behalf of the MASH study group Response to Letter by Chan et al Stroke, May 1, 2007; 38(5): e15 - e15. [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Rhoney and D. Parker Jr Considerations in Fluids and Electrolytes After Traumatic Brain Injury Nutr Clin Pract, October 1, 2006; 21(5): 462 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. van den Bergh and on behalf of the MASH Study Group Randomized Controlled Trial of Acetylsalicylic Acid in Aneurysmal Subarachnoid Hemorrhage: The MASH Study Stroke, September 1, 2006; 37(9): 2326 - 2330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Thanthulage, S. G. Stacey, and A. G. Doufas Magnesium sulphate and ischaemic heart disease Br. J. Anaesth., March 1, 2006; 96(3): 403 - 404. [Full Text] [PDF]
|
|
|
|
|
|
V. L. Feigin and M. Findlay Advances in Subarachnoid Hemorrhage Stroke, February 1, 2006; 37(2): 305 - 308. [Full Text] [PDF]
|
|
|
|
|
|
V. K. Gupta Magnesium for Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: Time for a Paradigm Shift? Stroke, December 1, 2005; 36(12): 2530 - 2530. [Full Text] [PDF]
|
|
|
|
|
|
G. K.C. Wong, R. Boet, W.S. Poon, M. T.V. Chan, W. van den Bergh, G. Rinkel, A. Algra, and On behalf of the MASH Study group Trial Design in "Magnesium Sulphate in Aneurysmal Subarachnoid Hemorrhage: A Randomized Controlled Trial" * Response: Stroke, December 1, 2005; 36(12): 2530 - 2532. [Full Text] [PDF]
|
|