DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195613

Correlation of serum calcium levels with infarct size and severity of stroke using NIHSS score in patients with acute ischemic stroke

Prabhakar K., Pujitha S. N., Phaneesh Bharadwaj B. S.

Abstract


Background: Normal cerebral membrane integration is important to maintain the cellular calcium homeostasis. Recent studies have suggested that elevated serum calcium levels at presentation correlates well with the infarct size and severity of stroke.

Methods: A total of 73 patients with acute ischemic stroke satisfying inclusion and exclusion criteria were included in the study from November 1st 2017 to April 30th 2019 at a tertiary care centre in Kolar, Karnataka. Serum calcium (total, ionized and albumin corrected calcium) levels were measured at the time of presentation and compared with the infarct size and severity of stroke using NIHSS score (National Institute of Health Stroke Scale).

Results: The levels of total calcium, albumin-corrected calcium, and ionized calcium were 9.13±0.89 mg/dL (range: 8.24-10.02), 9.56±0.82 mg/dL (range: 8.74-10.38), and 4.79±0.47 mg/dL (range: 4.3-5.2), respectively. Mean stroke size as measured on the CT scan was 47.38±17.7 cm (range: 21-88). Analysis revealed significant negative correlation between calcium levels (total, corrected, and ionized) and infarct size and severity of stroke.

Conclusions: In this study, it was found that there was a statistically significant negative correlation between total, ionized and corrected calcium with the infarct size in patients with ischemic stroke and also the total calcium at presentation and severity of stroke calculated using NIHSS score.


Keywords


Acute ischemic stroke, Infarct size, NIHSS, Total calcium

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References


Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the Am Heart Association. circulat. 2017;135(10):e146-603.

Mitchell SV, Elkind, Ralph LS. Pathogenesis, classification and epidemiology of cerebrovascular disease. Merritt’s Neurology, 12th edition, Lippincott Williams &Wilkins 2010; 253-265.

Banerjee TK, Das SK. Fifty years of stroke researches in India. Annals Ind Acad Neurol. 2016;19(1):1.

Kaul S, Bandaru VC, Suvarna A, Boddu DB. Stroke burden and risk factors in developing countries with special reference to India. J Ind Med Associat. 2009;107(6):358-67.

Dearden NM. Ischaemic brain. The Lancet. 1985;326(8449):255-9.

Heuser D, Guggenberger H. Ionic changes in brain ischaemia and alterations produced by drugs. British J anaesthesia. 1985;57(1):23-33.

White BC, Wiegenstein JG, Winegar CD. Brain ischemic anoxia: mechanisms of injury. Jama. 1984;251(12):1586-90.

Farber JL, Chien KR, Mittnacht Jr S. Myocardial ischemia: the pathogenesis of irreversible cell injury in ischemia. The Am J pathol. 1981;102(2):271.

Chung JW, Ryu WS, Kim BJ, Yoon BW. Elevated calcium after acute ischemic stroke: association with a poor short-term outcome and long-term mortality. J stroke. 2015 ;17(1):54.

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;67(1):170-3.

Buck BH, Liebeskind DS, Saver JL, Bang OY, Starkman S, Ali LK,et al. Association of higher serum calcium levels with smaller infarct volumes in acute ischemic stroke. Archives of neurol. 2007;64(9):1287-91.

Sims JR, Gharai LR, Schaefer PW, Vangel M, Rosenthal ES, Lev MH, Schwamm LH. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurol. 2009;72(24):2104-10.

D'Erasmo E, Pisani D, Romagnoli S, Ragno A, Acca M. Acute serum calcium changes in transient ischemic attack and cerebral infarction. J med. 1998;29(5-6):331-7.

Kasundra GM, Sood I, Bhushan B, Bohra GK, Supriya PS. Clinico-radiological correlation between serum calcium and acute ischemic stroke. Intern J Advanced Med and Health Res. 2014;1(2):69.

MacDonald JF, Xiong ZG, Jackson MF. Paradox of Ca2+ signaling, cell death and stroke. Trends in neurosciences. 2006;29(2):75-81.