Acute Decrease in Serum Magnesium Level after Ischemic Stroke May Not Predict Decrease in Neurologic Function

Abstract

Background Higher serum levels of magnesium (Mg(2+)) may contribute to improved outcome following ischemic stroke, and this may be related to vessel recanalization. Patients with low or normal serum magnesium levels during the acute phase of ischemic stroke may be more susceptible to neurologic deterioration and worse outcomes. Methods All patients who presented to our center within 48hrs of acute ischemic stroke (07/2008-12/2010) were retrospectively identified. Patient demographics, laboratory values, and multiple outcome measures, including neurologic deterioration (ND), were compared across admission serum Mg(2+) groups as well as change in Mg(2+) from baseline to 24hr groups. Results Three hundred thirteen patients met inclusion criteria (mean age 64.8 years, 42.2% female, 64.0% black). Mg(2+) groups at baseline were not predictive of poor functional outcome, death or discharge disposition. Patients whose serum Mg(2+) decreased during the first 24hrs of admission were also not at greater odds of ND or poor outcome measures compared to patients with unchanging or increasing Mg(2+) levels. Conclusions Our results suggest that patients who have low Mg(2+) at baseline or a reduction in Mg(2+) 24hrs after admission are not at a higher risk of experiencing ND or poor short-term outcome. Ongoing prospective interventional trials will determine if hyperacute aggressive magnesium replacement affords neuroprotection in stroke.

Neuroprotective Effect of Quercetin during Cerebral Ischemic Injury Involves Regulation of Essential Elements, Transition Metals, Cu/Zn Ratio, and Antioxidant Activity

“…Other studies show that decreased Mg level is implicated in the occurrence of oxidative stress, inflammation, lipid peroxidation, metabolic syndrome, and cerebral ischemia [23,24]. Additionally, a clinical study has evidenced that patients with low serum Mg levels during the acute phase of ischemic stroke may be more susceptible to neurologic deterioration and worse outcomes, and the trend of our experimental finding is in line with the preceding study [25]. As mentioned above, it is notable that a decrease in Mg level is harmful to the brain.…”

Admission Low Magnesium Level Is Associated with In-Hospital Mortality in Acute Ischemic Stroke Patients

“…A Chinese study reported that higher serum magnesium concentrations were associated with a lower risk of NIHSS >10 or death at discharge [12]. However, in another study involving 313 AIS patients, a higher risk of poor short-term outcomes was not present in patients with low magnesium levels at baseline or a reduction in magnesium levels at 24 h after admission [13]. In an interesting study from Turkey, the cerebrospinal fluid (CSF) magnesium level was shown to be lower in acute ischemic or hemorrhagic stroke patients than in the control group, and low CSF magnesium predicted a higher 1-week mortality [14].…”

“…The potential mechanisms by which magnesium reduces the risk of ischemic stroke involve an improvement in endothelial function and the inhibition of blood platelet aggregation [10,11]. However, evidence on the association between serum magnesium levels at admission and early outcomes in acute ischemic stroke (AIS) patients are limited and conflicting [12,13,14]. …”

Serum magnesium levels in patients of ischemic stroke and its correlation with neurological disability

“…16 However, Siegler et al, found that acute decrease in serum magnesium level after ischemic stroke was not associated with a poor neurological outcome but it was a retrospective study and effect of confounding cannot be excluded and also they did not take renal function of the patients into consideration. 17 But even then they found a relationship between magnesium levels at baseline and magnesium replacement with NIHSS over time. The reason for these discrepancies may be due to factors that lead to changes in serum magnesium levels like fluid replacement during early hours of patient admission and diuretic use.…”