“Lower calcium levels might simply be a marker or surrogate for another disease-modifying condition,” they suggest.

“Although the causal and mechanistic links are currently abstruse, this new study provides important insights into novel factors that may influence ICH size and the risk of expansion,” the editorial concludes. “Considering the relative lack of progress in unraveling the pathophysiology of ICH, these new findings are welcome and needed. We can easily and rapidly increase serum calcium levels if this simple intervention might reduce the risk of hematoma expansion. But I doubt it will be that simple. It almost never is when dealing with strokes.”

Dr. Walter M. van den Bergh from University Medical Center Groningen, The Netherlands told Reuters Health by email, “What is surprising is that low calcium levels almost double the risk, but the most interesting is that the relation with ICH expansion offers a window for intervention (e.g., calcium supplementation).”

“That remains to be seen after an intervention study,” he cautioned. “In massive bleeding, calcium supplementation is routine; this might be the case in ICH management if future randomized controlled trials are successful.”