|
1
|
Feulner J, Weidinger CS, Dörfler A, Birkholz T, Buchfelder M, Sommer B. 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. World Neurosurg 2024; 186:e106-e113. [PMID: 38514031 DOI: 10.1016/j.wneu.2024.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
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.
Collapse
Affiliation(s)
- Julian Feulner
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany; Department of Neurosurgery, Klinikum Fürth, Fürth, Germany
| | | | - Arnd Dörfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Torsten Birkholz
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Björn Sommer
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany; Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany.
| |
Collapse
|
|
2
|
Galijasevic M, Steiger R, Treichl SA, Ho WM, Mangesius S, Ladenhauf V, Deeg J, Gruber L, Ouaret M, Regodic M, Lenhart L, Pfausler B, Grams AE, Petr O, Thomé C, Gizewski ER. Could Phosphorous MR Spectroscopy Help Predict the Severity of Vasospasm? A Pilot Study. Diagnostics (Basel) 2024; 14:841. [PMID: 38667486 PMCID: PMC11049300 DOI: 10.3390/diagnostics14080841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
One of the main causes of the dismal prognosis in patients who survive the initial bleeding after aneurysmal subarachnoidal hemorrhage is the delayed cerebral ischaemia caused by vasospasm. Studies suggest that cerebral magnesium and pH may potentially play a role in the pathophysiology of this adverse event. Using phosphorous magnetic resonance spectrocopy (31P-MRS), we calculated the cerebral magnesium (Mg) and pH levels in 13 patients who suffered from aSAH. The values between the group that developed clinically significant vasospasm (n = 7) and the group that did not (n = 6) were compared. The results of this study show significantly lower cerebral Mg levels (p = 0.019) and higher pH levels (p < 0.001) in the cumulative group (all brain voxels together) in patients who developed clinically significant vasospasm. Further clinical studies on a larger group of carefully selected patients are needed in order to predict clinically significant vasospasm.
Collapse
Affiliation(s)
- Malik Galijasevic
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ruth Steiger
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephanie Alice Treichl
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Wing Man Ho
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Stephanie Mangesius
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Miar Ouaret
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Milovan Regodic
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Lukas Lenhart
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Astrid Ellen Grams
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ondra Petr
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Elke Ruth Gizewski
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
|
3
|
Choudhary N, Bhalotra AR, Magoon R. The role of magnesium in perioperative management of intracranial aneurysm surgery: A case series. Saudi J Anaesth 2021; 15:219-221. [PMID: 34188647 PMCID: PMC8191280 DOI: 10.4103/sja.sja_1065_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
As the motivation to potentially allow for a more expansive role of opioid-sparing anaesthesia in various surgical specialities transpire with new zeal, promising evidence needs to be accumulated to substantiate the same. Appropriate to this context, the index case series highlight the beneficial effects of an intraoperative magnesium sulphate infusion on perioperative hemodynamic profile and postoperative recovery in patients undergoing intracranial cerebral aneurysm surgery.
Collapse
Affiliation(s)
- Nitin Choudhary
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anju R Bhalotra
- Department of Anaesthesiology and Intensive care, Maulana Azad Medical College, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
|
4
|
Neuroprotective effect of magnesium supplementation on cerebral ischemic diseases. Life Sci 2021; 272:119257. [PMID: 33631176 DOI: 10.1016/j.lfs.2021.119257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/31/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Ischemic encephalopathy is associated with a high mortality and rate of disability. The most common type of ischemic encephalopathy, ischemic stroke, is the second leading cause of death in the world. At present, the main treatment for ischemic stroke is to reopen blocked blood vessels. However, despite revascularization, many patients are not able to achieve good functional results. At the same time, the strict time window (<4.5 h) of thrombolytic therapy limits clinical application. Therefore, it is important to explore effective neuroprotective drugs for the treatment of ischemic stroke. Magnesium is a natural calcium antagonist, which exerts neuroprotective effects through various mechanisms. However, while most basic studies have shown that magnesium supplementation can help treat cerebral ischemia, intravenous magnesium supplementation in large clinical trials has failed to improve prognosis of ischemic patients. Therefore, we review the basic and clinical studies of magnesium supplementation for cerebral ischemia. According to the route of administration, treatment can be divided into intraperitoneal magnesium supplementation, intravenous magnesium supplementation, arterial magnesium supplementation and intracranial magnesium supplementation. We also summarized the potential influencing factors of magnesium ion intervention in cerebral ischemia injury. Finally, in combination with influencing factors derived from basic research, this article proposes three future research directions, including magnesium supplementation into the circulatory system combined with magnesium supplementation in the lateral ventricle, magnesium supplementation in the lateral ventricle combined with hypothermia therapy, and lateral ventricle magnesium supplementation combined with intracarotid magnesium supplementation combined with selective hypothermia.
Collapse
|
|
5
|
Barry O, Wang Y, Wahl G. Determination of baseline alveolar mucosa perfusion parameters using laser Doppler flowmetry and tissue spectrophotometry in healthy adults. Acta Odontol Scand 2020; 78:31-37. [PMID: 31349769 DOI: 10.1080/00016357.2019.1645353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To determine the baseline perfusion parameters of the alveolar mucosa using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS) in healthy adults.Material and methods: Forty-two healthy adult subjects of either sex were tested. The perfusion of the alveolar mucosa was evaluated using a laser Doppler flowmetry and tissue spectrophotometry using O2C 'oxygen to see' device. The measurements encompassed the maxillary and mandibular mucosa at 20 different points.Results: The O2C device is a reliable method for noninvasive measurement of different perfusion parameters of the oral mucosa. The hemoglobin saturation values (So2 in %), as well as relative amount of hemoglobin in arbitrary units (AU) of the maxillary mucosa demonstrated lower values of that in the mandible. The flow value (AU) exhibited a significant difference in the posterior molar region only, while the velocity value (AU) showed a significant difference across all points except for the anterior region.Conclusion: the present study provides a set of brand-new perfusion parameters of the microcirculation of the alveolar mucosa using LDF-TS. The study suggests a variation of the perfusion parameters between the maxilla and the mandible. Differences in the anatomy of the blood supply, the thickness of the mucosa and the cortical bone, may be attributed to this variation. Further studies using different probes and a combination of ultrasonic measurements and SDF imaging will aid in giving a better overview of the perfusion in the oral mucosa.
Collapse
Affiliation(s)
- Obada Barry
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| | - Ying Wang
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| | - Gerhard Wahl
- Department of Oral Surgery, Bonn University Dental Clinic, Bonn, Germany
| |
Collapse
|
|
6
|
Kunze E, Lilla N, Stetter C, Ernestus RI, Westermaier T. Magnesium Protects in Episodes of Critical Perfusion after Aneurysmal SAH. Transl Neurosci 2018; 9:99-105. [PMID: 30191076 PMCID: PMC6124155 DOI: 10.1515/tnsci-2018-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/20/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To analyze whether magnesium has a neuroprotective effect during episodes that indicate a critical brain perfusion after aneurysmal subarachnoid hemorrhage (SAH). METHODS 107 patients with aSAH were randomized to continuously receive intravenous magnesium sulfate with target serum levels of 2.0 - 2.5 mmol/l (n = 54) or isotonic saline (n = 53). Neurological examination and transcranial Doppler sonography (TCD) were performed daily, Perfusion-CT (PCT) was acquired in 3-day intervals, angiography in case of suspected vasospasm. The primary endpoint was the development of secondary infarction following episodes of delayed ischemic neurological deficit (DIND), elevated mean flow velocity (MFV) in TCD or pathological findings in PCT. RESULTS In the magnesium group, 9 episodes of DIND were registered, none was followed by secondary infarction. In the control group, 23 episodes of DIND were registered, 9 were followed by secondary infarction (p < 0.05). In the magnesium group, 114 TCD-measurements showed an elevated MFV(> 140 cm/s). 7 were followed by new infarction. In control patients, 135 measurements showed elevated MFV, 32 were followed by new infarction (p < 0.05). 10 of 117 abnormal PCT-findings were followed by new infarction, compared to 30 of 122 in the control-group (p < 0.05). CONCLUSION DIND, elevated MFV in TCD and abnormal PCT are findings which are associated with an increased risk to develop delayed secondary infarction. The results of this analysis suggest that magnesium-treatment may reduce the risk to develop infarction in a state of critical brain perfusion.
Collapse
Affiliation(s)
- Ekkehard Kunze
- Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Nadine Lilla
- Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Christian Stetter
- Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| |
Collapse
|