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Subarachnoid Hemorrhage in the Setting of Electroconvulsive Therapy in a Patient With an Unsecured Cerebral Aneurysm

A Case Report and Review of the Literature

Gugger, James J. MD, PharmD; Dunn, Lauren E. MD

doi: 10.1097/YCT.0000000000000573
Case Report

Objectives The aim of the study was to report a case of a patient who experienced a fatal aneurysmal subarachnoid hemorrhage during the course of electroconvulsive therapy (ECT).

Methods This is a case report and review of the literature.

Results Electroconvulsive therapy is widely viewed as a safe and effective treatment for major depressive disorder; however, there remains some uncertainty regarding the safety of ECT in patients with cerebral aneurysms. Many cases exist documenting the safety of ECT in patients with both secured and unsecured cerebral aneurysms; however, these patients had aneurysms that were associated with a low (ie, ≤2.6%) 5-year cumulative rupture rate, whereas the patient in our case had an aneurysm associated with a 14.5% five-year cumulative rupture rate.

Conclusions We stress that ECT should not be viewed as a universally safe procedure in patients with cerebral aneurysms and the 5-year cumulative aneurysm rupture rate should be used in the discussion of the risk-benefit ratio of ECT in patients with unsecured cerebral aneurysms.

From the Department of Neurology, Johns Hopkins Hospital, Baltimore, MD.

Received for publication October 24, 2018; accepted November 29, 2018.

Reprints: James J. Gugger, MD, PharmD, Department of Neurology, Johns Hopkins Hospital, Sheikh Zayed Tower, Rm 6005, 1800 Orleans St, Baltimore, MD 21287 (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

Online date: February 4, 2019

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