Cerebrospinal fluid magnesium level as a prognostic factor in ischaemic stroke

Abstract

Magnesium has been reported to have a dilatatory effect on cerebral arteries. Reduction of extracellular Mg+2 has been shown to be directly correlated with the intensity of cerebral spasm. A neuroprotective effect of magnesium in stroke has also been hypothesized. The aim of our study was to examine the Mg+2 levels in serum and cerebrospinal fluid (CSF) in the early stage of stroke and to evaluate the correlation between Mg+2 levels and the development of neurological deficits. Between 1986 and 1994, 96 patients who had a stroke of 24- to 48-h duration were enrolled in the study. Serum and CSF levels of magnesium were checked on admission, 2448 h after the onset of stroke. Using a neurological score, the neurological deficit was assessed on the 1st day, 1 and 4 weeks later. Computed tomography (CT) was performed after 1 week, and the volume and location of infarction were calculated and measured. Statistical analysis was performed for cortical and subcortical patients separately, using Spearman correlation and multiple linear and logistic regression analyses. Significant correlation was found between CSF Mg+2 and the size of the infarct (P < 0.0001). There was no correlation between serum Mg+2 and CSF Mg+2 levels. Regression analysis demonstrated an increase in the values of the Mathew Neurological Score with higher CSF Mg+2 levels. This association remained true after other factors such as age, associated heart disease, diabetes and infarction size had been taken into account by the regression model. The results confirm that there is a relationship between a low Mg+2 concentration in CSF during the first 48 h after onset of ischaemic stroke and the intensity of the neurological deficit. The therapeutic consequence of this finding may have some importance.

Cerebral Ischemia Upregulates Vascular Endothelin ET B Receptors in Rat

“…We may speculate that either the mRNA is not translated to functional ET A receptors or there may be an enhanced turnover rate of ET A receptors in order to eliminate the high levels of ET-1 after cerebral ischemia. [1][2][3] ET has long-lasting contractile effects on cerebral vessels, which results in hypoperfusion and may therefore be detrimental in the event of ischemia. An upregulation of contractile ET receptors may exacerbate the ischemic region.…”

“…ince the discovery of an increased concentration of endothelin (ET) in both plasma 1 and cerebrospinal fluid 2,3 after cerebral ischemia, there has been much discussion regarding its possible involvement in the pathophysiology of cerebral ischemia. As yet the mechanisms of its role remain elusive.…”

Serum Calcium as Prognosticator in Ischemic Stroke

“…6 To our knowledge very few attempts have been made to investigate the impact of serum Ca 2ϩ level on clinical outcomes after ischemic stroke. [7][8][9] A recent study suggested that calcium levels obtained within 24 hours of stroke onset are associated with better hospital discharge clinical outcomes. 9 However, this finding requires confirmation and it remains unclear as to whether timing of calcium level is of prognostic significance.…”

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

“…Significant alterations of intracellular and extracellular free Mg +2 in ischemic and [13][14][15][16]. The relationship between serum or CSF Mg +2 levels and neurological findings of ischemic and traumatic cerebral damage have been investigated in clinical and experimental studies [11,17].…”

“…Although some have proposed that low Mg +2 is a risk factor for cerebrovascular diseases [10], few studies have investigated Mg +2 levels in the cerebrospinal fluid (CSF) in patients with acute stroke [11]. The aim of this study was to investigate the relationship between serum and CSF Mg +2 levels, Glasgow Coma Score (GCS), and 7-day in-hospital mortality in stroke patients presenting to the emergency department (ED) within 3 h of symptom onset.…”