Background and Objectives: Calcium homeostasis and blood pressure regulation play crucial roles in stroke pathophysiology. This study investigated associations between serum calcium levels, blood pressure parameters, and infarct volume in acute ischemic stroke.

Methods: We conducted a cross-sectional study of 100 consecutive patients with acute ischemic stroke presenting within 24 hours of symptom onset. Serum calcium levels were measured within 6 hours of admission. Infarct volume was calculated using semi-automated volumetric analysis of neuroimaging. Multiple linear regression analyzed independent predictors of infarct volume.

Results: Mean age was 64.5±12.3 years with 58% males. Median infarct volume was 28.5 mL (IQR: 12.3-68.4). Corrected calcium showed significant correlation with infarct volume (r=0.45, p<0.001), as did systolic blood pressure (r=0.38, p<0.001). In multivariable analysis, each 0.1 mmol/L increase in corrected calcium was associated with 8.24 mL larger infarct volume (95% CI: 3.98-12.50, p<0.001). Patients in the highest calcium tertile (>2.46 mmol/L) had median infarct volumes of 48.6 mL compared to 16.8 mL in the lowest tertile (p<0.001). Thirty-day mortality was 24.2% in the highest versus 6.1% in the lowest calcium tertile (p=0.044).

Conclusion: Elevated serum calcium levels are independently associated with larger infarct volumes in acute ischemic stroke. These findings suggest calcium measurement may provide prognostic information and identify high-risk patients requiring aggressive management.