Byline: Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Mehsa Hashim and Eisha Hanan
Keywords: Stroke, Serum calcium, Scandinavian stroke severity scale, Cerebral ischaemia.
Stroke is categorised as the number one cause of disability and the third most common cause of mortality worldwide. Literature reports that an estimated 6.5 million people lose their lives due to stroke every year, out of which 75% deaths occur in developing countries. 1 The majority of strokes in Pakistan are a result of cerebral ischaemia, with the most common type being lacunar stroke. 2 TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification of stroke has classified the causes of ischaemic stroke into: large artery atherosclerosis, cardio-embolism, small vessel disease, other determined aetiologies and undetermined causes. 3 Multiple variables have an impact on the prognosis and outcome of stroke, such as age, comorbidities, cause of stroke, location and severity of stroke, level of consciousness and blood glucose. 3
Calcium is known to play a significant role in the pathogenesis of ischaemic stroke, since cerebral ischaemia causes an increase in intracellular calcium resulting in activation of cytotoxic enzymes leading to cell death. 4 The present study was conducted to determine the correlation, if any, between serum calcium and severity of acute ischaemic stroke, and to establish the local perspective as there is a paucity of local data even though we are burdened with a large number of people presenting with acute ischaemic stroke.
Patients/Methods and Results
A retrospective observational study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, from January 2018 to December 2018, after taking ethical approval from the Ethical Review Committee (2018-0267-153). All patients presenting acutely within 24 hours of suffering stroke with CT scan at the time of admission showing a hypodense area, plus any two or more of the following symptoms inability to move one or more limb, aphasia, imbalance and GCS <15, were labelled as acute ischaemic stroke. Severity of the stroke was measured according to the Scandinavian stroke scale (SSS). Patients with a history of mania, bipolar effective disorder or post-traumatic stress, history of thyroid and parathyroid disorders, history of blood transfusion within one week, history of CNS disease (e.g. head trauma, multiple sclerosis), and with history of congestive heart failure, chronic renal failure, chronic obstructive pulmonary disease and chronic liver disease, were excluded. A score of less than 43 was...