Serum magnesium level and hematoma expansion in patients with intracerebral hemorrhage.

Mostafa Jafari, Mario Di Napoli, Simona Lattanzi, Stephan A Mayer, Salam Bachour, Eric M Bershad, Rahul Damani, Yvonne H Datta, Afshin A Divani

Journal: Journal of the neurological sciences 2020;398():39-44

PMID: 30682519

Full Text on Elsevier Science View on PubMed

Abstract

Spontaneous intracerebral hemorrhage (ICH) is a devastating subtype of stroke that results in significant rates of mortality and morbidities. The initial hematoma volume, hematoma expansion (HE), blood pressure (BP), and coagulopathy are considered strong predictors of clinical outcomes and mortality. Low serum magnesium (Mg) levels have been shown to be associated with larger initial hematoma and greater HE. Coagulopathy, platelet dysfunction, high BP, and increased inflammatory response might form the mechanistic link between low serum Mg levels, larger hematoma size and greater HE. However, randomized clinical trials administering intravenous Mg have shown no benefit over placebo in ICH patients. The confounding effect of hypocalcemia and a delay in Mg trafficking across the blood-brain barrier might explain the futile results for intravenous Mg therapy. In the current review, we will discuss the evidence regarding the possible role of low serum Mg level on HE in acute ICH.

Address: Department of Neurology, University of Minnesota, Minneapolis, MN, United States.; Department of Neurology, San Camillo de' Lellis District General Hospital, Rieti, Italy.; Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.; Department of Neurology, Henry Ford Health System, Detroit, MI, United States.; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States.; Department of Neurology, Baylor College of Medicine, Houston, TX, United States.; Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.; Department of Neurology, University of Minnesota, Minneapolis, MN, United States; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States. Electronic address: [email protected].

DOI: 10.1016/j.jns.2019.01.027

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MeSH Terms: Biomarkers, Blood Pressure, Cerebral Hemorrhage, Hematoma, Humans, Magnesium