Serum magnesium level and hematoma expansion in patients with intracerebral hemorrhage

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. •ICH is a devastating subtype of stroke that results in significant rates of mortality and morbidities.•The initial hematoma volume, HE, blood pressure, and coagulopathy are considered strong predictors of clinical outcomes.•Low serum Mg++ levels have been shown to be associated with larger initial hematoma and HE.•However, randomized clinical trials administering intravenous Mg++ have shown no benefit over placebo in ICH patients.•Hypocalcemia and a delay in Mg++ trafficking across the BBB might explain the futile results for intravenous Mg++ therapy.