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

Background: Magnesium sulfate (MgSO₄) is a potential neuroprotective agent for patients with aneurysmal subarachnoid hemorrhage (SAH). We analyzed the effect of early application of intraoperative intravenous MgSO₄ and compared cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and neurological outcome in 2 patient cohorts.

Methods: A retrospective matched-pair analysis from patients at a single center in Germany was performed without (group A) and with (group B) MgSO₄ application <24 hours 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 and DCI and neurological outcome using the modified Rankin Scale score 3 and 12 months after SAH were recorded.

Results: The inclusion criteria were met by 196 patients. After risk stratification, 48 patients were included in the final analysis (age 54.2 ± 8.1 years; 30 women and 18 men) and were assigned to group A (n = 24) or group B (n = 24). CV occurred less frequently in group B (33%) than in group A (46%). Likewise, DCI was present in 13% in group B compared with 42% in group A. After 12 months, 22 patients in group B had a favorable functional outcome (modified Rankin Scale score 0-3) compared with 15 patients in group A.

Conclusions: In this study, the incidence of CV and DCI was lower in patients receiving intravenous MgSO₄ within 24 hours after aneurysmal SAH onset. Favorable functional outcome was more likely in the MgSO₄ group after 12 months of follow-up.

Keywords: Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; Delayed cerebral ischemia; Functional outcome; Magnesium sulfate.