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Table of Contents    
CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 280-281

Magnesium: Hope for prehospital care in intracranial hemorrhage


1 Department of Internal Medicine, IPGMER, Kolkata, India
2 Department of Internal Medicine, Mount Sinai St. Luke's Hospital, New York, USA
3 Department of Internal Medicine, NMB Diagnostics, Serampore, West Bengal, India

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Adrija Hajra
Department of Internal Medicine, IPGMER, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222878

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How to cite this article:
Hajra A, Bandyopadhyay D, Hajra SK. Magnesium: Hope for prehospital care in intracranial hemorrhage. Neurol India 2018;66:280-1

How to cite this URL:
Hajra A, Bandyopadhyay D, Hajra SK. Magnesium: Hope for prehospital care in intracranial hemorrhage. Neurol India [serial online] 2018 [cited 2019 Jul 21];66:280-1. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/280/222878




Sir,

We like to thank the authors of “A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage” for their extensive discussion on spontaneous intracranial hemorrhage (ICH) management.[1] Patients who present with Glasgow Coma Scale (GCS) 4–8, hematoma volume 31–60 ml, midline shift of more than 5 mm, and intraventricular extension of the hematoma will be benefited by surgical management.[1],[2] In this regard, we want to highlight an interesting point. Prehospital care for stroke patients is a very crucial aspect to be kept in mind. Magnesium has been studied for the past few years as a treatment option for prehospital care in acute stroke. FAST-MAG (The Field Administration of Stroke Therapy–Magnesium trial) published previously did not show a treatment benefit (particularly a neuroprotective effect in reducing disability at 90 days) of magnesium administered in the prehospital setting. This finding was observed among patients with suspected hyperacute stroke.[3] However, magnesium sulfate is found to be cerebroprotective in various animal models. It has both vasodilatory and direct neuroprotective and glioprotective effects. Magnesium is inexpensive, widely available, and easy to administer; its side effect profile is also favorable.[4]

Recently, data supporting the hypothesis that magnesium exerts a clinically meaningful effect on hemostasis in patients with ICH has been published.[5] Magnesium plays a significant role in coagulation through the tissue factor–activated factor VII pathway, factor IX, as well as platelet aggregation. The study showed that lower admission magnesium levels were associated with larger initial hematoma volumes. The finding was evident on univariate, parsimoniously-adjusted, as well as fully-adjusted models (P< 0.02). Lower serum magnesium level at hospital admission was independently associated with larger baseline as well as final hematoma volumes. A lower magnesium level was also related to hematoma growth and was associated with a worse functional outcome at 3 months.

However, undoubtedly this study had some limitations. Only the effect of magnesium level within 6 hours of symptom onset has been observed in this study.[5]

The exact time-window would be necessary to know when the effect of magnesium level would play a significant role in the pathogenesis of hematoma expansion. The observation will also guide the therapeutic dosage of the administered medications.

We hope that this new treatment modality may change the mortality as well as morbidity patterns in ICH patients in the future. We will be enriched if the authors would kindly give their opinion regarding this issue.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bhaskar MK, Kumar R, Ojha B, Singh SK, Verma N, Verma R, et al. A randomized controlled study of operative versus nonoperative treatment for large spontaneous supratentorial intracerebral hemorrhage. Neurol India 2017;65:752-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Mendelow A D. Operation versus non-operative treatment for spontaneous supratentorial intracerebral haemorrhage: Is a change in current clinical practice required?. Neurol India 2017;65:759-60.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Can magnesium stop bleeding in ich, improve outcomes? Medscape. Available from: http://www.medscape.com/viewarticle/884699. [Last accessed on 2017 Aug 31].  Back to cited text no. 3
    
4.
Saver JL, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S, et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke. N Engl J Med 2015;372:528-36.  Back to cited text no. 4
    
5.
Liotta EM, Prabhakaran S, Sangha RS, Bush RA, Long AE, et al. Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage. Neurology 2017;89:813-9.  Back to cited text no. 5
    




 

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