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Tijdschrift voor Psychiatrie 51 (2009) 1, 43 - 51

Review article

Electroconvulsive therapy for patients with intracranial aneurysms: a case study and literature review

E. van Herck, P. Sienaert, A. Hagon

summary
background Electroconvulsive therapy (ect) is an effective treatment for severe psychiatric disorders, such as mood disorders and schizophrenia. ect is a safe treatment, even in the presence of somatic comorbidity. There are no absolute contraindications to ect, although a few somatic conditions can constitute an increased risk. ect causes a transient increase in blood pressure and heart rate and an increase in cerebral blood flow. In the presence of intracranial vascular malformations such as aneurysms, these haemodynamic changes can, in theory, increase the risk of bleeding.
aim To determine the safety of ect for patients with an intracranial aneurysm.
methods We performed a Medline-search of articles published from 1967 to 2007 using Mesh-terms 'electroconvulsive therapy', 'central nervous system vascular malformations', 'intracranial arteriovenous malformations' and 'intracranial aneurysm', and the search term 'intracranial vascular malformations'. The literature data was supplemented with a case report concerning a man with bipolar disorder and a treated aneurysm of the internal carotid artery, a ventriculoperitoneal drain and hypertension, who was treated with ect.
results The literature reported 15 cases in which ect was administered to patients with a treated or untreated aneurysm. In most cases blood-pressure-lowering steps were taken. There were no reports of any complications connected with the presence of the aneurysm. Even in the case described, ect was successful and without complications.
conclusion The presence of intracranial aneurysms is no contraindication to ect. Blood pressure should be carefully monitored. It may be worth considering the use of antihypertensive agents and/or an anaesthetic with blood-pressure-lowering qualities. Prior to the application of ect careful attention should be given to the possible advantages and disadvantages of the treatment, and in addition the psychiatric and somatic state of the patient should be taken into account.

keywords bipolar disorder, electroconvulsive therapy, intracranial aneurysms, propofol