Acute serum calcium changes in transient ischemic attack and cerebral infarction

Total (T-Ca), albumin corrected (A-Ca) and ionized (Ca++) serum calcium levels were measured in patients affected by transient ischemic attack (TIA) and ischemic cerebral infarction (ICI), in order to evaluate the clinical and prognostic significance of calcemic status during the acute phase of these events. These results demonstrate that the calcium level is decreased in cerebral ischemia and that more substantial changes are observed in ICI than in TIA and controls (p < 0.0001, p < 0.02 and p < 0.0001 respectively for T-Ca, A-Ca and Ca++; analysis of variance). The mean T-Ca was significantly reduced in patients who died during hospitalization compared with values observed in survivors (p < 0.005), whereas A-Ca and Ca++ were not different. The calcium changes observed in the early phase of TIA and ICI suggest that the severity of cerebral ischemia may condition the amount of its acute decrease. The cause of hypocalcemia is unclear (primary effect or secondary epiphenomenon of cerebral ischemia?), but when A-Ca and Ca++ are considered, its in-hospital unfavorable prognostic role may be excluded.