Severity of Acute Ischemic Stroke and Its Relationship to Serum Calcium: A hospital Based Study

Background: Calcium plays a crucial role in neuronal excitability in addition to ischemic injury. Research suggests that altered calcium homeostasis could influence the severity of acute ischemic stroke (AIS). This research aimed to evaluate the relationship between serum calcium levels and the clinical and radiologic severity of AIS. Methods: This observational case control research included 90 adults with first-ever AIS admitted within 24 hours of symptom onset. Patients were categorized into two equal groups based on ionized calcium: low calcium (< 4.5 mg/dL) and high calcium (≥ 4.5 mg/dL). Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), and infarct size measured on diffusion-weighted MRI. Results: Patients with low calcium had significantly higher NIHSS scores (median 16 [10.5–21.5] vs 11 [7–13.5], p < 0.001) and lower GCS scores (10.96 ± 2.92 vs 13.38 ± 1.72, p < 0.001). Median infarct volume was markedly greater in the low-calcium group (34 [14.5–57.18] cm³ vs 14.5 [6.5–17.45] cm³, p < 0.001). Ionized calcium showed strong negative correlations with infarct size (r = –0.718, p < 0.001), NIHSS (r = –0.585, p < 0.001) a positive correlation with GCS (r = 0.555, p < 0.001). Total calcium correlated negatively with NIHSS (r = –0.435, p < 0.001) Conclusion: Lower serum calcium, especially ionized calcium, is strongly associated with greater stroke severity larger infarct size in AIS. Calcium measurement on admission could be a simple and practical biochemical indicator of neurological,radiologic severity in acute ischemic stroke