Open Access

J. Feulner, Christina L. Wolfert, C. S. Weidinger, A. Dörfler, T. Birkholz, H. Schmitt, M. Buchfelder, Ehab Shiban, Björn Sommer

• Background: Magnesium sulfate (MgSO4) is a well-known neuroprotective agent, although existing data for the use in patients with aneurysmal subarachnoid hemorrhage (SAH) is ambivalent. We investigated the effect of early (<24 hours) application of intraoperative intravenous magnesium sulfate and compared the rate of cerebral vasospasm (CV), delayed cerebral ischemia (DCI) and neurological outcome in two patient cohorts. Methods: A retrospective single-center analysis was performed in two distinct time frames without (2004-2005, group A) and with (2014-2015, group B) MgSO4 administration within 24 hrs after SAH onset. Inclusion criteria were 1) aneurysmal SAH, 2) endovascular or microsurgical treatment. Incidence of vasospasm, delayed cerebral ischemia (DCI), and neurological outcome after hospital discharge were recorded. Results: A total of 722 patients were screened. Of those, 101 patients fulfilled the inclusion criteria and belonged to group A, 78 to group B. All patientsBackground: Magnesium sulfate (MgSO4) is a well-known neuroprotective agent, although existing data for the use in patients with aneurysmal subarachnoid hemorrhage (SAH) is ambivalent. We investigated the effect of early (<24 hours) application of intraoperative intravenous magnesium sulfate and compared the rate of cerebral vasospasm (CV), delayed cerebral ischemia (DCI) and neurological outcome in two patient cohorts. Methods: A retrospective single-center analysis was performed in two distinct time frames without (2004-2005, group A) and with (2014-2015, group B) MgSO4 administration within 24 hrs after SAH onset. Inclusion criteria were 1) aneurysmal SAH, 2) endovascular or microsurgical treatment. Incidence of vasospasm, delayed cerebral ischemia (DCI), and neurological outcome after hospital discharge were recorded. Results: A total of 722 patients were screened. Of those, 101 patients fulfilled the inclusion criteria and belonged to group A, 78 to group B. All patients received nimodipin for prophylaxis of CV. SAH Hunt and Hess grade I-III was present in 49 (A) and 48 (B) patients. SAH grade IV-V was seen in 39 and 30 patients, respectively. In the group A, cerebral vasospasm was detected in 27 patients (27%), in the MgSO4 group in 19 patients (24%) by transcranial ultrasound or digital subtraction angiography. Nineteen patients (19%) of group A had an associated delayed ischemic deficit compared to 11 patients (14%) in group B. Neurological outcome at discharge was mRS 3.1±1.5 (A), whereas group B had an mRS of 1.9±1.6. Conclusion: In this retrospective cohort study, the incidence of cerebral vasospasm and delayed ischemic deficit was lower in patients treated with early intravenous MgSO4.…