Electrolyte abnormalities are common in acute stroke patients and have a substantial impact on the course and prognosis of the disease. Electrolyte imbalances such as hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and phosphate abnormalities are frequently seen in this patient population. The incidence, root causes, and medical ramifications of electrolyte abnormalities in acute stroke patients are investigated in this comprehensive study. According to our research, hyponatremia is the most prevalent electrolyte imbalance. The most common reason for hyponatremia in stroke patients is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Higher mortality rates, longer hospital admissions, and less favorable functional outcomes are all linked to hyponatremia. Acute stroke patients also typically experience hypokalemia, which affects the severity of the stroke and the recovery of functional abilities. The review furthermore emphasizes the incidence and clinical consequences of hypercalcemia, hypomagnesemia, hypophosphatemia, and hypocalcemia in patients with acute stroke. The results highlight the significance of early electrolyte imbalance detection and treatment in acute stroke patients. To better comprehend therapeutic approaches, evaluate their influence on stroke outcomes, and analyze prognostic implications, more research is required.

Prevalence of Electrolyte Imbalance in Patients With Acute Stroke: A Systematic Review.

Background and purpose Following mechanical thrombectomy (MT), patients with large artery occlusive acute ischemic stroke (LAO-AIS) often have cerebral herniation due to its complications, resulting in poor prognosis. Decompressive craniectomy (DC) can markedly improve patient prognosis. This study aimed to verify the predictive value of clinical parameters such as the systemic immune-inflammatory index (SII) for DC in patients with LAO-AIS after MT. Methods Clinical data of a total of 173 patients with LAO-AIS treated with MT between January 2020 and January 2022 were retrospectively analyzed. Patients receiving DC were grouped into an experimental group or a control group (no DC). The patients were randomly divided into the training set (n = 126, 75%) and validation set (n = 43, 25%). Multivariate logistic regression was used to construct a nomogram predictive model. Results The SII value in the experimental group (median: 2851.1×109/L) was significantly higher than that in the control group (median: 1898.6 × 109/L) (P = 0.019). Receiver operating characteristic (ROC) analyses showed that the best cutoff value of the SII was 2505.7 × 109/L with a sensitivity of 55%, a specificity of 75.8%, and an area under the curve (AUC) of 0.649. Multivariate logistic regression indicated that the SII was an independent predictor for performing DC in patients with LAO-AIS after MT (OR = 3.579, 95% CI = 1.360–9.422, P = 0.01). The AUC was 0.728 in the training set and 0.583 in the validation set. The average error of the calibration curve was 0.032 in the training set and 0.023 in the validation set. The average error was relatively small and consistent in the training set and validation set. The C-index of the nomogram was 0.804 suggesting good accuracy. Conclusions The SII at admission is an independent predictor for the requirement of DC in patients with LAO-AIS after MT. The SII-based nomogram helps doctors make decisions on whether DC is needed timely and rationally, and thereby may improve the prognosis of these patients.

https://www.frontiersin.org/articles/10.3389/fneur.2022.945437/pdf

Systemic immune inflammatory index is an independent predictor for the requirement of decompressive craniectomy in large artery occlusion acute ischemic stroke patients after mechanical thrombectomy

Neurologic injury continues to be a debilitating worldwide disease with high morbidity and mortality. The systemic sequelae of a neural insult often lead to prolonged hospital stays and challenging nutritional demands that contribute to poorer prognoses. Clinical management of a given condition should prioritize preserving the homeostatic parameters disrupted by inflammatory response cascades following the primary insult. This focused review examines the reciprocal relationship between electrolyte disturbance and neurologic injury. A prolonged electrolyte imbalance can significantly impact morbidity and mortality in neurologic injuries. A detailed overview of the major electrolytes and their physiologic, iatrogenic, and therapeutic implications are included. The pathophysiology of how dysnatremias, dyskalemias, dyscalcemias, and dysmagnesemias occur and the symptoms they can induce are described. The manifestations in relation to traumatic brain injury, status epilepticus, and acute ischemic stroke are addressed. Each type of injury and the strength of its association with a disruption in either sodium, potassium, calcium, or magnesium is examined. The value of supplementation and replacement is highlighted with an emphasis on the importance of early recognition in this patient population. This review also looks at the current challenges associated with correcting imbalances in the setting of different injuries, including the relevant indications and precautions for some of the available therapeutic interventions. Based on the findings of this review, there may be a need for more distinct clinical guidelines on managing different electrolyte imbalances depending on the specified neurologic injury. Additional research and statistical data on individual associations between insult and imbalance are needed to support this potential future call for context-based protocols.

Electrolyte Imbalance and Neurologic Injury.

Highlight: Ischemic stroke is a major public health issue in Indonesia. Clinical data correlated to an ischemic stroke patient's prognosis. Several clinical factors and laboratory testing describe the tendency of ischemic stroke patients. ABSTRACT Introduction: In Indonesia, ischemic stroke is a major public health issue. Clinical data correlates with an ischemic stroke patient’s prognosis. Objective: This study aimed to provide an overview of clinical data in ischemic stroke patients from October 2020 to December 2021. Methods: This was a retrospective, descriptive study using medical records. A non-probability purposive sampling strategy with a total sampling method is used in this study. Age, gender, cardiac comorbidities, diabetes, repeated strokes, blood laboratory exams, electrolyte tests, alcohol consumption, and smoking habits were all observed variables. Results: The sample consisted of 242 ischemic stroke patients. The majority of patients (32.23%) were in the 61 to 70 age group, and men (57.4%) made up the majority of the sex group. Then, cardiac comorbidities were dominated by coronary artery disease (CAD), with 33 patients (57.4%) with 4 deaths (12.1%), while 15 patients (6.19%) were found with atrial fibrillation (AF), with 7 deaths (46.67%). Hypertension was found in 81.40% of patients, diabetes in 26.03% of patients, and recurrent stroke in 31.40% of patients. Active smokers make up 52.06% of all patients, and 18.18% are heavy alcohol drinkers. The majority of patients showed blood and electrolyte levels within the normal range, except for an increased leukocyte count and a decreased potassium level. Conclusion: The main risk factors obtained sequentially are hypertension, coronary artery diseases, active smokers, diabetes, and excessive alcohol consumption. 

pdf/ischemic-stroke-risk-factor-profile-at-prof-dr-w-z-johannes-wsdi03z89o.pdf

Ischemic Stroke Risk Factor Profile at Prof. Dr. W. Z. Johannes Hospital, Kupang, East Nusa Tenggara

Background/Aim: Stroke is a significant cause of death along with malignant neoplasm and cardiovascular disease. Comorbidities and laboratory abnormalities are common in stroke patients. Imaging methods are the gold standard in the differential diagnoses of stroke, but they are not used sufficiently to diagnose stroke, especially in underdeveloped countries. In this study, we aimed to examine the association between electrolytes and clinical outcomes in patients with hemorrhagic and ischemic stroke.
Methods: Patients diagnosed with a stroke in the emergency department for one year were reviewed for this retrospective cohort study. We separated the patients into two groups, hemorrhagic and ischemic stroke, according to their diagnosis. Demographic, clinical features, laboratory, and imaging results were compared for the two groups. Potassium and sodium variables and receiver operating characteristic (ROC) analysis were used to predict the stroke status of individuals.
Results: In total, we included 321 patients in our study; 114 (35.5%) patients had experienced a hemorrhagic stroke, and 207 (64.5%) patients had had an ischemic stroke. In the hemorrhagic stroke group, 64% were males, while 50.2% of the ischemic stroke group were males. The most common chronic disease was found to be hypertension in both groups (42.1% (hemorrhagic) and 33.3% (ischemic)). There was a statistically significant difference in the comparison of potassium and sodium parameters and diagnostic groups (P=0.021 and P=0.036). In addition, hypokalemia was found to be significant in the diagnosis of hemorrhagic stroke (P<0.001).
Conclusion: Using potassium levels in the differential diagnosis of ischemic and hemorrhagic stroke is especially useful in the management of patients who cannot undergo imaging.

Association of potassium and sodium parameters with the type of stroke

Introduction Electrolyte disturbances are commonly reported in acute stroke in studies conducted in the western world. Presently, the data available about the prevalence of electrolyte disturbance in patients with stroke are not sufficient, especially from developing countries. The purpose of our study is to determine the frequency of occurrence of electrolyte imbalance in patients presenting with acute stroke in a tertiary care hospital. Methods This descriptive cross-sectional study was conducted in the department of internal medicine and neurology in a tertiary care hospital, Pakistan, from December 2019 to March 2021. A total of 300 patients, aged between 30 and 70 years, with either ischemic or hemorrhagic stroke, as diagnosed on contrast tomography (CT) scan of the head or magnetic resonance imaging (MRI) of the brain, were enrolled in the study. The biochemical analysis of the stroke patients was done. Results Out of the 300 participants, 139 (46.3%) participants were from the ischemic stroke group while 161 (53.7%) were from the hemorrhagic stroke group. The mean sodium level was significantly lower in the ischemic group as compared to the hemorrhagic group (129.41 ± 3.12 mEq/L vs. 134.42 ± 3.46 mEq/L; p-value: <0.0001). Potassium level was significantly higher in the hemorrhagic group compared to the ischemic group (6.27 ± 1.12 mmol vs. 4.31 ± 0.71 mmol; p-value: <0.0001). Conclusion Patients coming to emergency with stroke should be screened immediately for electrolyte imbalance. Early identification of rapid imbalances of serum electrolytes may aid in prompt medical intervention and resultant improved outcomes in stroke patients. It is crucial that electrolyte imbalances in these patients are closely monitored to avoid any complications.

Frequency of Electrolyte Imbalance in Patients Presenting With Acute Stroke.

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Frequency of Electrolyte Imbalance in Patients Presenting With Acute Stroke.