ECT and intracranial vascular masses

In 1990, the APA Task Force on ECT cited no "absolule" controindications to ECT but "Substantial Risk" to be associated with ECT for patients with spa ce occupying or other cerebral lesions with increased intracranial pressure and with bleeding or otherwise unstable vascular aneurysm or malformation. These findings indicate that patients with intracranial vascular masses ar e at increased risk for serious morbidity and mortality. Several authors ha ve reported performing ECT in patients with intracranial vascular masses wi thout adverse events by monitoring blood pressure both with and without pha rmacologic intervention. Given the relatively recent change in practice of considering ECT for patients with intracranial vascular masses and the few number of cases thus Car reported, Lye present a review of the existing lit erature and two additional cases of ECT performed with good result and no a dverse events. With the cases we have presented, the literature now contain s eight cases of ECT performed in patients with intracranial vascular masse s, none of which had adverse outcomes. While such numbers do not establish unequivocal safety in this population, and the individual ECT practitioner must continue to make a risk/benefit analysis on a case-by-case basis, this report adds to the growing literature on the safety and efficacy of ECT fo r such patients.