DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201084

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

Vishali Kotwal, Rajesh Maini

Abstract


Background: Stroke is a leading cause of death and disability worldwide acute ischaemic stroke accounts for 87% of strokes and mostly affects persons at the peak of their lives. Magnesium is known to have neuroprotective effects in ischemic stroke through a variety of mechanisms including decrease in glutamate release and inhibition of NMDA receptors and vasodilation. Previous studies on serum magnesium levels in stroke patients have shown variable results with many of them finding lower levels than in normal subjects. This study was undertaken to compare serum magnesium levels in patients of acute ischemic stroke with those of controls and also find a correlation if any between serum magnesium levels and neurological disability.

Methods: This was a prospective non-interventional case-control study in which 50 patients of acute ischemic stroke in the age group of 20 to 80 years admitted in the department of Medicine Government Medical College Jammu from October 2019 to January 2020 were taken. Their serum magnesium levels were analysed within first 24 hours of admission and neurological disability was measured using modified Rankin Score. Serum magnesium levels were also estimated in 35 healthy controls for comparison.

Results: Serum magnesium was lower in the study group (mean of 1.85±0.36) as compared to the control group (mean of 2.4±0.21) which was statistically significant (p value =0.001). Modified Rankin Score was 4 to 5 in 27 patients and 2 to 3 in 23 patients and it was negatively correlated with serum magnesium levels (r =-0.67).

Conclusions: Ischemic stroke patients had lower serum magnesium levels as compared to healthy subjects in our study and also lower levels were seen in those with higher neurological disability.


Keywords


Ischemic stroke, Modified Rankin score, Neuroprotection, Serum magnesium

Full Text:

PDF

References


Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014 Jan 18;383(9913):245-55.

Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009 Apr 1;8(4):345-54.

Kamalakannan S, Gudlavalleti AS, Gudlavalleti VS, Goenka S, Kuper H. Incidence and prevalence of stroke in India: A systematic review. Ind J Med Res. 2017 Aug;146(2):175.

Panahi Y, Mojtahedzadeh M, Najafi A, Rajaee SM, Torkaman M, Sahebkar A. Neuroprotective Agents in the Intensive Care Unit:-Neuroprotective Agents in ICU. J Pharmacopun. 2018 Dec;21(4):226.

Hoyte L, Barber PA, Buchan AM, Hill MD. The rise and fall of NMDA antagonists for ischemic stroke. Curr Mol Med. 2004 Mar 1;4(2):131-6.

Chamorro Á, Amaro S, Castellanos M, Segura T, Arenillas J, Martí-Fábregas J, et al. Safety and efficacy of uric acid in patients with acute stroke (URICO-ICTUS): a randomised, double-blind phase 2b/3 trial. Lancet Neurol. 2014 May 1;13(5):453-60.

Feng S, Yang Q, Liu M, Li W, Yuan W, Zhang S, et al. Edaravone for acute ischaemic stroke. Cochrane Data Syst Rev. 2011 Dec 7;12:CD007230.

Álvarez-Sabín J, Román GC. The role of citicoline in neuroprotection and neurorepair in ischemic stroke. Brain Sci. 2013 Sep;3(3):1395-414.

Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators. Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke trial): randomised controlled trial. Lancet. 2004 Feb 7;363(9407):439-45.

Qu X, Jin F, Hao Y, Li H, Tang T, Wang H, Yan W, Dai K. Magnesium and the risk of cardiovascular events: a meta-analysis of prospective cohort studies. PloS One. 2013;8(3):577520.

Muir KW. Magnesium in stroke treatment. Postgrad Med J. 2002 Nov 1;78(925):641-5.

Cojocaru IM1, Cojocaru M, Burcin C, Atanasiu NASerum magnesium in patients with acute ischemic stroke. Rom J Inter Med. 2007;45(3):269-73.

Lampl Y, Geva D, Gilad R, Eshel Y, Ronen L, Sarova-Pinhas I. Cerebrospinal fluid magnesium level as a prognostic factor in ischaemic stroke. J Neurol. 1998 Aug 1;245(9):584-8.

Bayır A, Ak A, Kara H, Şahin TK. Serum and cerebrospinal fluid magnesium levels, Glasgow Coma Scores, and in-hospital mortality in patients with acute stroke. Biol Trace Element Res. 2009 Jul 1;130(1):7-12.

Ovbiagele B, Liebeskind DS, Starkman S, Sanossian N, Kim D, Razinia T, et al. Are elevated admission calcium levels associated with better outcomes after ischemic stroke?. Neurol. 2006 Jul 11;67(1):170-3.

Saberi A, Hatamian HR, Esmaeilzadeh K, Heydarzadeh A. The relationship between magnesium level and first 72 hours Rankin score and Rankin score in 1 week after an ischemic stroke. Iran J Neurol. 2011;10(1-2):26.

Siegler JE, Boehme AK, Albright KC, Bdeir S, Kar AK, Myers L, et al. Acute decrease in serum magnesium level after ischemic stroke may not predict decrease in neurologic function. Journal of Stroke Cerebro Dis. 2013 Nov 1;22(8):e516-21.