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|Year : 2018 | Volume
| Issue : 1 | Page : 282-283
Authors' Reply: Magnesium supplementation in intracerebral hematoma: The hope and the hype!
Mukesh K Bhaskar1, Bal Krishna Ojha1, Rajesh Verma2
1 Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||11-Jan-2018|
Dr. Bal Krishna Ojha
Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhaskar MK, Ojha BK, Verma R. Authors' Reply: Magnesium supplementation in intracerebral hematoma: The hope and the hype!. Neurol India 2018;66:282-3
We would like to convey our sincere thanks to the authors of this letter for showing keen interest in our article  and the commentary related to it, and for raising the important point related to the association between the serum level of magnesium, and the hematoma expansion as well as the outcome, in patients with intracranial hemorrhage. The role of magnesium sulphate and its supplementation in stroke has been highlighted in many trials.,
The various properties of magnesium sulphate described in literature, namely its N-methyl-D-aspartate receptor (NMDA) blocking effect, its anti-glutamate action, its role in increasing cerebral blood flow, its role in inhibiting intracellular entry of calcium, and its vasodilator effect, have been exploited in trials pertaining to neuroprotection in stroke. The FAST –MAG (field administration of stroke therapy– magnesium) trial studied the neuroprotective effect of magnesium sulphate and evaluated the factors concerned with clinical outcome. The other related study did not convincingly showed the benefit of magnesium sulphate therapy in acute ischemic stroke, although attesting to the safety of magnesium supplementation.
Hematoma expansion is undoubtedly one of the critical determining factors in the outcome of hemorrhagic stroke. In the recent past, much hope has been generated that with the manipulation of the coagulation cascade in patients who have suffered from a primary intracerebral hemorrhage, the expansion of hematoma may be prevented with a consequent good prognosis. The recombinant factor VIIa was initially studied in 399 subjects. The study revealed a reduction in the clot size and concluded that the factor VIIa administered group showed a better clinical outcome. The subsequent high powered large scale study failed to show clinical benefits. This negative study, however, does not close the chapter for the assessment of hemostatic agents in the reduction of primary intracerebral hematoma (ICH).
Recently, a study was published in Neurology, highlighting the effect of low magnesium level on clot expansion in patients who have had a primary ICH. The authors found that those patients who were having a low serum magnesium had a larger initial hematoma volume, a greater incidence of hematoma expansion, and a worse clinical outcome at 90 days. This study was conducted on 290 patients. A low serum magnesium level adversely affected the prognosis, a fact substantiated by a high modified Rankin's scale (with an odds ratio 0.14 [P = 0.11]) after adjustment of other variables.
This confirms the role of magnesium in achieving intracranial hemostasis. However, there are many unresolved issues. The effect of magnesium on the coagulation cascade needs more mechanistic insights.
Our opinion is that more high-powered studies are required to establish the role of magnesium in the achievement of hemostasis and for establishing its correlation with the amount of hematoma volume and clot growth in patients suffering from a primary ICH.
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Conflicts of interest
There are no conflicts of interest.
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