Magnesium protects in episodes of critical perfusion after aneurysmal SAH

Kunze, Ekkehard; Lilla, Nadine; Stetter, Christian; Ernestus, Ralf‐Ingo; Westermaier, Thomas

doi:10.1515/tnsci-2018-0016

Cited by 9 publications

(14 citation statements)

References 34 publications

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“…Although neurological involvement is a quite common feature in GS, to date no one has demonstrated the presence of EMG alterations. We postulate that hypomagnesemia may impair the normal nerve trophism, since the importance of Mg2+ in neuroprotection is well described (15). Finally, we reported a GS with a novel SCL12A3 variation: to our knowledge, this is the very first heterozygous mutation in exon 23 (2738G>A), because the only other case of mutation involving exon 23, described in a Chinese case report, was homozygous and its nucleotide change was 2744 G>A (1).…”

Section: Case Reportmentioning

confidence: 86%

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Conticini

Negro²,

Magnani

et al. 2020

Reumatismo

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Gitelman syndrome (GS) is an inherited salt-wasting tubulopathy characterized by hypocalciuria, hypokalemia, hypomagnesemia and metabolic alkalosis, due to inactivating mutations in the SLC12A3 gene. Symptoms may be systemic, neurological, cardiovascular, ophthalmological or musculoskeletal. We describe a 70 year-old patient affected by recurrent arthralgias, hypoesthesia and hyposthenia in all 4 limbs and severe hypokalemia, complicated by atrial flutter. Moreover, our patient reported eating large amounts of licorice, and was treated with medium-high dosages of furosemide, thus making diagnosis very challenging. Genetic analysis demonstrated a novel heterozygous mutation in the SLC12A3 gene; therefore, we diagnosed GS and started potassium and magnesium replacement. GS combined with chondrocalcinosis and neurological involvement is quite common, but this is the first case of an EMG-proven severe neuropathy associated with GS. Herein, we underline the close correlation between hypomagnesemia, chondrocalcinosis and neurological involvement. Moreover, we report a new heterozygous mutation in exon 23 (2738G>A), supporting evidence of a large genetic heterogeneity in this late-onset congenital tubulopathy.

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Section: Case Reportmentioning

confidence: 86%

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Conticini

Negro²,

Magnani

et al. 2020

Reumatismo

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“…For a more detailed description of our institutional management of aSAH patients, we refer to our previous works [ 14 , 18 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…In our institution, we have studied the effects of magnesium sulfate in aSAH patients extensively in experimental as well as in clinical studies [ 14 , 18 , 19 ]. Unlike several multicentric studies that administered magnesium in a fixed-dose manner and failed to find beneficial effects [ 20 ], a randomized controlled trial in our institution demonstrated the effectiveness of a tailored magnesium therapy guided by serum concentration.…”

Section: Introductionmentioning

confidence: 99%

Serum concentration–guided intravenous magnesium sulfate administration for neuroprotection in patients with aneurysmal subarachnoid hemorrhage: a retrospective evaluation of a 12-year single-center experience

Wipplinger,

Cattaneo,

Wipplinger

et al. 2023

Neurosurg Rev

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Delayed cerebral infarction (DCI) is a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). The benefits of magnesium sulfate as an alternative treatment are controversial, and most previous studies examined its benefits only as adjunctive treatment to traditional nimodipine. We retrospectively analyzed aSAH patients records with magnesium sulfate between 2010 and 2021. We aimed for a serum magnesium concentration of 2–2.5 mmol/l between post-hemorrhage days 3 and 12. The patients were separated in three groups based on average serum magnesium concentration (magnesium >2 mmol/l, reduced magnesium 1.1–1.9 mmol/l, and no magnesium). Additionally, we assessed delayed cerebral infarction (DCI) and clinical outcome at follow-up, using the modified Rankin Scale (mRS), categorized in favorable (0–3) and unfavorable outcome (4–5). In this analysis, 548 patients were included. Hereof, radiological evidence of DCI could be found in 23.0% (n = 126) of patients. DCI rates were lower if patients’ average serum magnesium was higher than 2 mmol/l (magnesium 18.8%, n = 85; reduced magnesium 38.3%, n = 23; no magnesium 51.4%, n = 18; p < 0.001). Also, at the last follow-up, patients in the group with a higher serum magnesium concentration had better outcome (favorable outcome: magnesium 64.7%, n = 293; reduced magnesium 50.0%, n = 30; no magnesium 34.3%, n = 12; p < 0.001). This 12-year study reveals the value of serum concentration-guided magnesium administration in aSAH patients. Our findings demonstrate the safety and efficacy when titrated to a serum concentration of 2–2.5 mmol/l. We observed higher rates of delayed cerebral infarction and unfavorable outcomes in patients with serum concentrations below 2 mmol/l.

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“…Target values are maintained using isotonic fluid infusion, packed red blood cells, and norepinephrine. All patients receive continuous intravenous magnesium for neuroprotection, vasospasm, and DCI prophylaxis with a target serum concentration of 2-2.5 mmol/L for the first 14 days following aSAH [16][17][18].…”

Section: Institutional Standard Management Of Asah Patientsmentioning

confidence: 99%

Investigating the relationship between high-dose norepinephrine administration and the incidence of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage: A single-center retrospective evaluation

et al. 2023

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Background One of the longest-standing treatments to prevent delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains raising the blood pressure to a certain level of mean arterial pressure. This may require high doses of norepinephrine, which has been associated with severe end organ damage. With this study, we aimed to investigate the effects of norepinephrine on the incidence of DCI in a clinical setting. Methods We conducted a retrospective evaluation of patients with aSAH admitted to our institution between November 2018 and March 2021. Potential risk factors for DCI were analyzed and significant predictors were assessed by means of a logistic regression analysis to account for potential confounders. Results In this study, 104 patients were included. Hereof, 39 (38%) showed radiologic signs of DCI between day three and 14 post-intervention. These patients had more frequent vasospasms (n = 37 vs. 30, p = 0.022), a higher Hunt & Hess score (3 ± 2 vs. 2 ± 1, p = 0.004), a lower initial Glasgow Coma Scale score (9 ± 5 vs. 12 ± 4, p = 0.003) and received a higher median norepinephrine dose (20,356μg vs. 6,508μg, p < 0.001). A logistic regression analysis revealed that only high-dose norepinephrine administration (OR 2.84, CI 1.56–7.8) and vasospasm (OR 3.07, CI 1.2–7.84) appeared to be significant independent risk factors for DCI. Conclusion Our results indicate a significant association between higher dose norepinephrine administration and the occurrence of DCI. Future research including greater sample sizes and a prospective setting will be necessary to further investigate the relationship.

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Magnesium protects in episodes of critical perfusion after aneurysmal SAH

Cited by 9 publications

References 34 publications

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Serum concentration–guided intravenous magnesium sulfate administration for neuroprotection in patients with aneurysmal subarachnoid hemorrhage: a retrospective evaluation of a 12-year single-center experience

Investigating the relationship between high-dose norepinephrine administration and the incidence of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage: A single-center retrospective evaluation

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