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Kunz, Mathias (2005): Nimodipin versus Magnesium als Vasospasmusprophylaxe bei der Behandlung von Patienten mit aneurysmatischer Subarachnoidalblutung: Eine prospektiv randomisierte Pilotstudie. Dissertation, LMU München: Medizinische Fakultät



Abstract: Objective: The prophylactic use of nimodipine in patients with aneurysmal subarachnoid hemorrhage (SAH) reduces the risk of ischemic brain damage, however its efficacy appears rather moderate. The question arises whether other types of calcium antagonists offer better protection. Magnesium, nature's physiologic calcium antagonist, is neuroprotective in animal models, promotes dilatation of cerebral arteries, and has an established safety profile. The aim of the current study is to evaluate the efficacy of magnesium versus nimodipine to prevent delayed ischemic deficits after aneurysmal SAH. Methods: 113 patients with aneurysmal SAH were enrolled in the study and randomized to receive either magnesium sulfate (loading 10 mg/kg followed by 30 mg/kg/d) or nimodipine (48 mg/d) intravenously until postoperative day 7. Primary parameters were blood flow velocity as determined by daily transcranial Doppler (TCD), incidence of vasospasm and infarction, and outcome at discharge. Results: 104 patients met the study requirements. In the magnesium group (N=53) 8 patients (15%) developed symptomatic and 20 patients (38%) asymptomatic vasospasm according to TCD criteria compared to 14 (27%) and 17 (33%) patients in nimodipine the group (N=51). If symptomatic vasospasm occurred, 75% of the magnesium-treated versus 50% of the nimodipine-treated patients developed cerebral infarction resulting in fatal outcome in 37% and 14%, respectively. Overall there was no difference in outcome between groups. Conclusion: The observed trend towards a lesser incidence of symptomatic vasospasm in magnesium-treated patients and the lesser incidence of fatal outcome from symptomatic vasospasm in nimodipine-treated patients make future studies on the combined administration of magnesium and nimodipine appear promising.