Tehran University Medical Journal

Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH), cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI) as well as the neurological outcome after a period of three months.

Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS). Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS) and the patients were allocated to "Good" (GOS = 4, 5) and "Poor" (GOS= 1-3) outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.

Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05), whereas low serum magnesium levels during days 4-7 17% of patients) and the second week (22% of patients) after SAH were correlated with poor clinical outcome (p<0.05). No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.

Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

Background: Cerebrovascular ischemic accident is the third most common cause of death in community. Management of high-risk patients reduces complications and mortality. Serum lipid profile is one of the most important factors influencing the prognosis.

Methods: In this cross sectional study, 123 (58 female and 65 male) patients with acute ischemic stroke, mean aged 65.1± 11.16 years, were admitted to Sina Hospital between September 2008 and September 2009. The inclusion criteria were age between 40-90 years and ischemic stroke within the anterior or posterior brain blood system. The exclusion criteria were brain tumor or abscess, venous sinus thrombosis, liver disease, renal failure, hypothyroidism or metabolic problems. Serum lipid profile was evaluated during the first 24 hours after stroke and after 12 hours of fasting. Furthermore, the patients' inability was evaluated on the first and fifth day of hospitalization by NIH Stroke Scale (NIHSS).

Results: Patients' total serum cholesterol was 189.93± 51.46 mg/dl and mean total serum triglycerides was 157.72± 72.67 mg/dl. The mean HDL and LDL was 47.70± 14.43 and 105.98± 37 mg/dl, respectively. In the analysis, a significant inverse relationship was found between serum triglyceride levels and fifth day's NIHSS. In addition, age and a history of heart disease had a significant direct relationship with the first day's NIHSS. (p< 0.05)

Conclusion: The study showed a better prognosis in cases with increased plasma triglyceride levels, after cerebral ischemic stroke. Besides, older age and a history of ischemic heart disease were associated with a worse prognosis.

Background: Numerous studies have shown the protective effects of saffron against oxidative damage in a global model of cerebral ischemia, but its effects on brain edema and oxidative ischemic injury in focal ischemic stroke are not completely understood. Therefore, this study was designed to investigate the effects of saffron on brain edema, infarct volume, antioxidant enzyme activity (glutathione peroxidase and superoxide dismutase) and concentration of malondialdehyde (MDA) in ischemic brain tissue in an experimental model of stroke.

Methods: Focal brain ischemia was established with the temporary occlusion of the middle cerebral artery for one hour in rats. Saffron (100 mg/kg) was given intra-peritoneally at the onset of ischemia. 24 hours later, brain edema and infarct volume were evaluated and glutathione peroxidase and superoxide dismutase activities and MDA concentration were measured in the ischemic brain tissue using a specific kit.

Results: The results showed that saffron reduced infarct volume by 77% (P<0.001) and brain edema by 60% (P<0.001) compared with the control group in 24 hours following ischemia. Moreover, saffron significantly reduced the content of MDA (P<0.001) and increased the activity of superoxide dismutase (P<0.001) and glutathione peroxidase (P<0.001) in the cortex of the ischemic brain tissue.

Conclusion: Saffron has protective effects against oxidative ischemic damage and brain edema in a transient model of focal cerebral ischemia in rats. This protective effect is probably induced by increasing the capacity of antioxidant enzymes and decreasing the production of free radicals.