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(Stroke. 2005;36:2530-a.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Trial Design in "Magnesium Sulphate in Aneurysmal Subarachnoid Hemorrhage: A Randomized Controlled Trial"

Division of Neurosurgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China

Matthew T.V. Chan

Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the study by W.M. van den Bergh regarding the randomized controlled trial on Magnesium Sulfate in Aneurysmal Subarachnoid Hemorrhage¹. In essence, it was a negative study using delayed cerebral ischemia (DCI) and poor outcome at three months from the data provided.

The methodology raised concerns us. The author, for some unexplained reason, truncated out the aspirin group’s case selection as well as data to carry out the analysis. As noted in the MASH group’s trial protocol published in the Internet Stroke Center,² the way would be to add aspirin to the group that had aneurysm intervention within 4 days. If the aspirin group were actually excluded, the study population would be undoubtedly focused on patients with delayed aneurysm treatment. The study used DCI as the primary outcome measure and used CT evidence of infarct.

Magnesium is thought to be neuroprotective and reverse cerebral vasospasm in animal models. Thus, it would be of interest to look at their clinical vasospasm data and blood flow study data as Transcranial Doppler USG and SPECT. It would certainly enlighten about the possible actions of magnesium. The other reasons for the above data would be that some patterns of CT infarct may not be related to cerebral vasospasm, and some infarct may actually be masked by edema or metallic artifact as quoted by Rabinstein et al.³

The outcome was made in 3 months. From our experience, some of the poor-grade subarachnoid hemorrhage patients would show progressive . . . [Full Text of this Article]

Walter van den Bergh, MD; Gabriel Rinkel, MD, FAHA; Ale Algra, MD, FAHA On behalf of the MASH Study group