Serum and Cerebrospinal Fluid Magnesium Levels, Glasgow Coma Scores, and In-Hospital Mortality in Patients with Acute Stroke

Abstract

The aim of this study was to determine the relationship between serum and cerebrospinal fluid (CSF) magnesium(Mg+2) levels, Glasgow Coma Scores (GCS), and 7-day mortality in acute stroke patients. Patients with acute ischemic or hemorrhagic stroke arriving within the first 3 h of symptoms were included in the study. The control group consisted of healthy volunteers. GCS was determined, and blood and CSF samples were taken in order to establish serum and CSF glucose, Mg+2, sodium, potassium, calcium, and chlorine levels.Mortality was recorded at 7 days after admission. CSF Mg+2 in the ischemic infarct group was significantly lower than in the control group (p=0.006). CSF Mg+2 in the ischemic infarct patients with a GCS < or = 8 were significantly lower (p=0.002) than controls and in ischemic infarct patients with a GCS > or = 9. In the ischemic stroke patients, CSF Mg+2 and GCS were significantly correlated (r=55, p=0.031). CSF Mg+2 levels in ischemic stroke patients who died within 7 days were significantly lower than controls, ischemic stroke patients who survived, and hemorrhagic stroke patients who died (p=0.002, p=0.042, and p=0.005,respectively). Low CSF Mg+2 levels in patients with acute ischemic stoke at admission predicted a higher 1-week mortality.

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

“…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]. Any discrepancies between these studies may be partially due to differences in population, inclusion criteria, sample size, and primary outcomes.…”

“…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]. …”

Magnesium: Potential Roles in Neurovascular Disease

“…These studies did not demonstrate a correlation between serum Mg levels and Glasgow Coma Scale. However, lower cerebrospinal fluid (CSF) Mg levels were present in patients with ischemic strokes compared to controls ( p  = 0.006) and established a positive association between mortality after 7 days and significantly lower CSF levels of Mg ( p  = 0.002) (17). During cardiac bypass surgery (CABG), intra-operative serum Mg levels were found to be low during an initial stage of the operation (18).…”

Plasma Magnesium and Risk of Ischemic Stroke Among Women

“…However, in these studies, magnesium was not measured prior to the stroke diagnosis and thus hypomagnesaemia may have been a consequence rather than a cause of stroke in these patients. Nonetheless, magnesium may influence stroke severity and outcome; individuals with lower magnesium levels had worse post-stroke prognosis 13, 15 . Early data from a small randomized clinical trial suggested a benefit of intravenous magnesium on acute stroke prognosis and outcome 16 , but results from the Intravenous Magnesium Efficacy in Stroke (IMAGES) trial 17 as well as preliminary results from the FAST-MAG trial presented at the 2014 American Stroke Association’s International Stroke Conference failed to show any clinical benefit of intravenous magnesium infusion on stroke outcomes in the acute stroke setting.…”