MR ASSESSMENT OF MAGNESIUM IN ACUTE STROKE

Summary

Principal Investigator: CHELSEA M KIDWELL
Abstract: The objectives of this project are to demonstrate that 1) intravenous magnesium is beneficial in acute ischemic stroke as evidenced by decrease in the growth of infarct volume over time as measured by diffusion weighted magnetic resonance imaging (DWI); 2) DWI is a valuable surrogate outcome measure in acute ischemic stroke clinical trials; 3) diffusion/perfusion mismatch is a useful entry criterion for neuroprotective treatment in acute stroke clinical trials; and 4) intravenous magnesium is safe and potentially beneficial in intracerebral hemorrhage. During the first phase of the project, objectives 1-3 will be assessed by conducting a randomized, double-blind, placebo controlled trial to evaluate the efficacy of intravenous magnesium as a neuroprotective agent in acute ischemic stroke. The trial will use diffusion/perfusion magnetic resonance imaging as a surrogate outcome marker. 150 patients will be enrolled within 12 hours of symptom onset at 3 UCLA-associated hospitals. The second phase of this project will be a parallel pilot randomized, double-blind, placebo-controlled trial to evaluate the safety and explore the efficacy of intravenous magnesium in acute intracerebral hemorrhage, enrolling 40 patients. Additional data will be collected to assess the diffusion/perfusion MR signature of acute intracerebral hemorrhage. The findings of this project will have direct relevance to future treatment of acute ischemic and hemorrhagic stroke as well as to the design of future trials of neuroprotective agents. The results will help establish the utility of novel diffusion/perfusion MR techniques as demonstrating physiologic, objective changes that can be used as entry and outcome criteria in evaluating stroke patients. During the award period, in addition to serving as the principal investigator of these trials, Dr. Kidwell will pursue in-depth didactic multidisciplinary training in biostatistics, epidemiology, clinimetrics and magnetic resonance radiology. She will be mentored by Drs. Jeffrey Saver, Sidney Starkman, Jeffry Alger, and Barbara Vickrey. At the completion of this training, Dr. Kidwell will have acquired all requisite experience and skills to function as an independent investigator in clinical studies of novel magnetic resonance stroke imaging techniques, pivotal trials of promising therapeutic agents, and studies of the pathophysiology of acute human cerebral ischemia.
Funding Period: 1999-04-02 - 2005-03-31
more information: NIH RePORT

Top Publications

  1. ncbi Advanced MR imaging of acute stroke: the University of California at Los Angeles endovascular therapy experience
    David S Liebeskind
    University of California at Los Angeles Stroke Center, UCLA Medical Center, Los Angeles, CA 90095, USA
    Neuroimaging Clin N Am 15:455-66, xiii. 2005
  2. ncbi Evidence of publication bias in reporting acute stroke clinical trials
    David S Liebeskind
    Comprehensive Stroke Center and Department of Neurology, University of Pennsylvania, Philadelphia, USA
    Neurology 67:973-9. 2006
  3. ncbi Early MRI and outcomes of untreated patients with mild or improving ischemic stroke
    V Rajajee
    UCLA Medical Center, Los Angeles, CA, USA
    Neurology 67:980-4. 2006
  4. ncbi Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years
    D Kim
    University of California at Los Angeles Stroke Center, Department of Neurology, UCLA Medical Center, Los Angeles, CA, USA
    AJNR Am J Neuroradiol 28:159-63. 2007
  5. ncbi Diagnosis of lacunar infarcts within 6 hours of onset by clinical and CT criteria versus MRI
    Venkatakrishna Rajajee
    UCLA Medical Center, Los Angeles, CA, USA
    J Neuroimaging 18:66-72. 2008
  6. ncbi Thrombolytic toxicity: blood brain barrier disruption in human ischemic stroke
    Chelsea S Kidwell
    Department of Neurology, Georgetown University, Washington, DC 20010, USA
    Cerebrovasc Dis 25:338-43. 2008
  7. pmc Results of the MRI substudy of the intravenous magnesium efficacy in stroke trial
    Chelsea S Kidwell
    Georgetown University, Washington, DC 20007, USA
    Stroke 40:1704-9. 2009

Scientific Experts

  • D S Liebeskind
  • V Rajajee
  • D Kim
  • Chelsea S Kidwell
  • Sidney Starkman
  • Jeffry R Alger
  • Jeffrey L Saver
  • Christopher J Weir
  • Kennedy R Lees
  • Keith W Muir
  • Stephen M Davis
  • Christopher Chen
  • Deidre A De Silva
  • Reza Jahan
  • Fernando Vinuela
  • Steven Warach
  • Gary Duckwiler
  • Larry Latour
  • Dong Wha Kang

Detail Information

Publications7

  1. ncbi Advanced MR imaging of acute stroke: the University of California at Los Angeles endovascular therapy experience
    David S Liebeskind
    University of California at Los Angeles Stroke Center, UCLA Medical Center, Los Angeles, CA 90095, USA
    Neuroimaging Clin N Am 15:455-66, xiii. 2005
    ..The ensuing review emphasizes salient aspects of these neuroimaging studies, addressing numerous facets of acute stroke pathophysiology...
  2. ncbi Evidence of publication bias in reporting acute stroke clinical trials
    David S Liebeskind
    Comprehensive Stroke Center and Department of Neurology, University of Pennsylvania, Philadelphia, USA
    Neurology 67:973-9. 2006
    ..To ascertain the extent of publication bias in the reporting of acute stroke clinical trials...
  3. ncbi Early MRI and outcomes of untreated patients with mild or improving ischemic stroke
    V Rajajee
    UCLA Medical Center, Los Angeles, CA, USA
    Neurology 67:980-4. 2006
    ....
  4. ncbi Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years
    D Kim
    University of California at Los Angeles Stroke Center, Department of Neurology, UCLA Medical Center, Los Angeles, CA, USA
    AJNR Am J Neuroradiol 28:159-63. 2007
    ..The purpose of this study was to compare the baseline characteristics, complications, and outcomes between intra-arterially treated ischemic stroke patients aged > or = 80 years and their younger counterparts...
  5. ncbi Diagnosis of lacunar infarcts within 6 hours of onset by clinical and CT criteria versus MRI
    Venkatakrishna Rajajee
    UCLA Medical Center, Los Angeles, CA, USA
    J Neuroimaging 18:66-72. 2008
    ..Few studies have evaluated the accuracy of <6 hours presentation with lacunar clinical syndromes in predicting the presence of a SDI and the absence of large vessel occlusion...
  6. ncbi Thrombolytic toxicity: blood brain barrier disruption in human ischemic stroke
    Chelsea S Kidwell
    Department of Neurology, Georgetown University, Washington, DC 20010, USA
    Cerebrovasc Dis 25:338-43. 2008
    ..Early barrier opening caused by focal cerebral ischemia in human stroke can be assessed by the presence of gadolinium enhancement of cerebrospinal fluid, termed 'Hyperintense Acute Injury Marker' (HARM)...
  7. pmc Results of the MRI substudy of the intravenous magnesium efficacy in stroke trial
    Chelsea S Kidwell
    Georgetown University, Washington, DC 20007, USA
    Stroke 40:1704-9. 2009
    ..The Magnetic Resonance in IMAGES (MR IMAGES) substudy investigated the effects of magnesium on the imaging surrogate outcome of infarct growth...