Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Wednesday, November 2, 2016

Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage

Without telling us how outcomes were measured, this research is useless. I'm not going to pay for the full article.  Barthel and other measurements are not discriminatory enough, way too subjective. What is really needed is scans of the brain.
http://stroke.ahajournals.org/content/46/11/3190.abstract
Sanne M. Dorhout Mees, Ale Algra, George K.C. Wong, Wai S. Poon, Celia M. Bradford, Jeffrey L. Saver, Sidney Starkman, Gabriel J.E. Rinkel, Walter M. van den Bergh, Collaborators, F. van Kooten, C.M. Dirven, J. van Gijn, M. Vermeulen, R. Boet, M.T.V. Chan, T. Gin, S.C.P. Ng, B.C.Y. Zee, R. Al-Shahi Salman, J. Boiten, H. Kuijsten, P.M. Lavados, R.J. van Oostenbrugge, W.P. Vandertop, S. Finfer, A. O’Connor, E. Yarad, R. Firth, R. McCallister, T. Harrington, B. Steinfort, K. Faulder, N. Assaad, M. Morgan, M. Eckstein, S.J. Stratton, F.D. Pratt, S. Hamilton, R. Conwit, D.S. Liebeskind, G Sung, I. Kramer, G. Moreau, R. Goldweber and N. Sanossian and on behalf of the writing groups of MASH-I, IMASH, MASH-II, MASH and FAST-MAG

Abstract

Background and Purpose—Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH.
Methods—Patients were divided into categories according to the delay between symptom onset and start of the study medication: <6, 6 to 12, 12 to 24, and >24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI.
Results—We included 5 trials totaling 1981 patients; 83 patients started treatment <6 hours. For poor outcome, the adjusted risk ratios of magnesium treatment for start <6 hours were 1.44 (95% confidence interval, 0.83–2.51); for 6 to 12 hours 1.03 (0.65–1.63), for 12 to 24 hours 0.84 (0.65–1.09), and for >24 hours 1.06 (0.87–1.31), and for DCI, <6 hours 1.76 (0.68–4.58), for 6 to 12 hours 2.09 (0.99–4.39), for 12 to 24 hours 0.80 (0.56–1.16), and for >24 hours 1.08 (0.88–1.32).
Conclusions—This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH.

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