Electroconvulsive Therapy and Cerebral Aneurysms

Helgeson, Lars E.; Ostroff, Robert

doi:10.1097/yct.0000000000000163

Cited by 11 publications

(5 citation statements)

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“…We identified 11 cases where ECT was performed in elderly patients with identified Cerebral Aneurysm. [10][11][12][13][14][15][16][17][18][19][20] The report of a death due to aneurysmal rupture in one case undergoing ECT is alarming given the low reported mortality risk associated with ECT in general (only one death reported in the 9 studies published after 2001 with a total of 414,747 treatments). 6 This implies that the risk of death might be higher among elderly patients with cerebral aneurysms compared to other groups.…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

Mehdi

Devanand

2021

J Geriatr Psychiatry Neurol

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Introduction: Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited. Methods: We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT. Results: A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary to ictal hypertensive surge during treatment with ECT. Discussion: Risk factors such as history of hypertension, age of the patient, extent of the ictal surge in blood pressure, efficacy of prophylactic treatment to control surge in blood pressure and characteristics of cerebral aneurysm each elevated the risk of complication in these cases. We reviewed safety measures based on the evidence from the current literature available. Conclusion: ECT is safe in elderly patients with cerebral aneurysms provided appropriate safety measures are employed. Screening for cerebral aneurysms in high risk patients, effective prevention and management of blood pressure elevation acutely during ECT is the best practice to avoid adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

Mehdi

Devanand

2021

J Geriatr Psychiatry Neurol

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“…In addition, while approximately 5% of the adult population has intracranial aneurysms (varying between 0.2-9.9% in autopsy studies), no ruptured aneurysms induced by ECT have been reported (11). This is thought to be due to the restoration of the increased arterial blood pressure to normal ranges during ECT by administering medication (12).…”

Section: Discussionmentioning

confidence: 99%

Does a history of surgically repaired intracranial aneurysm interfere with electroconvulsive therapy?

Karakaya¹,

Başar²,

Aki³

et al. 2018

Dusunen Adam

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Does a history of surgically repaired intracranial aneurysm interfere with electroconvulsive therapy?Electroconvulsive therapy (ECT) is a comparably safe treatment option frequently administered for treatment-refractory mental disorders. It has no absolute contraindication; however, careful attention should be given when ECT is applied to patients with comorbid conditions. Intracranial aneurysms are among the comorbidities that increase certain risks associated with ECT. Increase in cerebral blood flow during ECT may be associated with increased risk of rupture of an aneurysm and bleeding from vascular malformation. In the literature, there is a limited number of case reports on ECT administration in patients with surgically repaired cerebral aneurysm. In this case report, application of ECT in a 53-year-old female patient diagnosed with treatment-refractory major depressive disorder and with a history of surgical repair for intracranial aneurysm is presented. In addition, special considerations and precautions about ECT application for patients with repaired intracranial aneurysms are reviewed.

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“…This represents the eighth report of a successful and uneventful ECT course in a patient with previously repaired cerebral aneurysm in a growing series of cases 3,4 that includes a patient having received ECT six days following balloon assisted liquid embolization. 5 In this case, as in most reports to date, ECT was tolerated without appreciable neurological complications, despite the presence of an intracranial metallic object (e.g.…”

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confidence: 88%

The Successful Use of Electroconvulsive Therapy in a Patient With Cerebral Aneurysms and a Pituitary Lesion

Kitay

Katz

Ostroff

2019

J ECT

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To the Editor Electroconvulsive therapy (ECT) remains one of the most effective treatments in the current psychiatric armamentarium yet recent reports highlight widespread underutilization despite its excellent safety profile. 1 Here, we seek to add to the growing list of case series of the safety of ECT use in patients with history of significant intracranial pathology. Ms. D is a 52-year-old woman with a history of recurrent, severe major depressive disorder with psychotic features admitted to our inpatient service for consideration of ECT with worsening psychosis and catatonic symptoms despite several psychotropic trials. In the year preceding admission, the patient had one additional hospitalization following a suicide attempt via cyclobenzaprine overdose. Her past medical history is notable for Hashimoto's thyroiditis, hypertension, a non-functional pituitary lesion (microadenoma vs. cyst), and two cerebral aneurysms diagnosed in 2012 on MRI/MRA as part of a workup for chronic migraine headaches. The 4×5×7-mm aneurysm at the trifurcation of the right middle cerebral artery (MCA) was successfully clipped in 2012 and the second aneurysm 1-mm from the M1 segment of the left MCA did not receive intervention. Since neurovascular intervention, the patient had received annual follow-up including serial neuroimaging without interval progression of aneurysms or the pituitary lesion described as a "hypoenhancing 5×6.6×5-mm left pituitary lobe lesion." Upon admission, clinical evaluation was for significant psychomotor slowing, minimal oral intake, perseveration, insomnia, and auditory hallucinations associated with depressed mood and suicidal thoughts. Despite documented history of hypertension, her blood pressure (BP) remained normotensive (range 98/69-122/93 mmHg) with mild tachycardia (heart rate, range 82-107 beats per minute) throughout inpatient admission without antihypertensive agents. Laboratory assessments were notable for an abnormal dexamethasone (1 mg) suppression test (DST, Cortisol 08:00 = 15.1 µg/dL, Cortisol 16:00 = 9.2 µg/dL), but otherwise unremarkable. Initial treatment included a benzodiazepine challenge for catatonia

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Electroconvulsive Therapy and Cerebral Aneurysms

Cited by 11 publications

References 0 publications

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations

Does a history of surgically repaired intracranial aneurysm interfere with electroconvulsive therapy?

The Successful Use of Electroconvulsive Therapy in a Patient With Cerebral Aneurysms and a Pituitary Lesion

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