Our study demonstrated that increased serum levels of alkaline phosphatase are an independent predictor of all-cause and vascular death after either ischemic or hemorrhagic stroke.

In active tuberculosis (TB), Mycobacterium tuberculosis-specific T cells are compartmentalized more to the site of infection than to the circulating blood. Therefore, an M. tuberculosis-specific enzyme-linked immunospot (ELISPOT) assay with samples from the site of infection may permit a more sensitive or specific diagnosis of active central nervous system (CNS) TB than that achieved by the assay with blood alone. Therefore, we prospectively evaluated the usefulness of circulating and compartmentalized mononuclear cell (MC; i. and 25 (68%) were classified as not having active TB. The sensitivity and specificity of the PBMC ELISPOT assay were 91% (95% confidence interval [CI], 59% to 100%) and 63% (95% CI, 41% to 81%), respectively. By comparison, the sensitivity and specificity of the CSF MC ELISPOT assay were 75% (95% CI, 19% to 99%) and 75% (95% CI, 43% to 95%), respectively. When the ratio of the CSF MC ELISPOT assay results to the PBMC ELISPOT results was 2 or more, the sensitivity and specificity were 50% (95% CI, 7% to 93%) and 100% (95% CI, 74% to 100%), respectively. The ELISPOT assay with PBMCs and CSF MCs is a useful adjunct to the current tests for the diagnosis of CNS TB.The diagnosis of central nervous system (CNS) tuberculosis (TB) remains a serious clinical problem (1). The signs and symptoms, the results of routine analyses of cerebrospinal fluid (CSF), and the radiologic findings for patients with CNS TB are often inadequate as a guide to the initiation of empirical therapy (1). Therefore, a rapid, sensitive, and specific test for the diagnosis of CNS TB is urgently required. Several newly developed assays for the diagnosis of TB based on Mycobacterium tuberculosis-specific antigens encoded by genes in the RD1 region gave promising results for the detection of latent TB infection and active pulmonary TB (10). However, data on the usefulness of these assays for the diagnosis of CNS TB in actual clinical practice are limited.The clinical use of the immunodiagnosis of TB is limited in regions where TB has intermediate to high levels of endemicity because it cannot differentiate active TB from latent TB infection (6). Recently, it has been shown that mononuclear cells (MCs) compartmentalized in infected sites such as pleural fluid (8,14) or bronchoalveolar lavage fluid (3, 5) have higher gamma interferon responses than peripheral blood mononuclear cells (PBMCs). We aimed to demonstrate the proof of concept for the ability of the enzyme-linked immunospot (ELISPOT) assay to differentiate active TB from latent TB using compartmentalized lymphocytes. Therefore, we prospectively evaluated the usefulness of circulating and compartmentalized MC-based ELISPOT assays for the diagnosis of active TB in patients with suspected CNS TB. MATERIALS AND METHODSAll adult patients with suspected CNS TB were prospectively enrolled at the Seoul National University Hospital, Seoul, Republic of Korea, and the Seoul National University Bundang Hospital in Gyunggi Province, Republic of Korea, between September 2006 and Augu...

Background: Lacunar infarctions account for up to 25% of all ischemic strokes and, thus, constitute a numerically important subgroup. It is important that the two pathogeneses of lacunar infarction, that is, small-vessel occlusion and branch atheromatous disease, be differentiated because prognoses and treatment strategies differ. The authors evaluated the presence of branch atheromatous plaque in parent arteries that supply lacunar infarcts by high-resolution magnetic resonance imaging (HR-MRI). Methods: HR-MRI was performed in 15 patients with (1) a clinical presentation consistent with classical lacunar syndromes; (2) an acute lacunar infarction by diffusion-weighted imaging, measuring ≤20 mm in maximal diameter; (3) a magnetic resonance angiography showing a normal middle cerebral artery or basilar artery supplying the ischemic lesion, and (4) no other obvious etiology for small-vessel distribution ischemic stroke. Results: The median time of vessel wall imaging after index events was 4 days (range, 2–15 days). Six of the 15 patients had a lacunar infarction in the middle cerebral artery territory, and 9 had a lesion in the basilar artery territory. HR-MRI detected underlying atheromatous plaques in 9 patients (60%) with a lacunar infarction. In these 9 patients, asymptomatic intracranial atherosclerotic stenosis was more frequent compared to patients without branch atheromatous plaque (55.6 vs. 16.7%). In pontine infarctions, ischemic lesions that extended to the pial base of the pons were more frequent in patients with branch atheromatous plaques (83.3 vs. 33.3%), and all the ischemic lesions and atheromatous plaques were on the same side (right, n = 2; left, n = 4). All plaques responsible for acute symptomatic lacunar infarction were enhanced in contrast-enhanced T1-weighted HR-MR images. Conclusions: HR-MRI results enabled underlying symptomatic branch atheromatous disease to be detected in lacunar infarction patients. The experience gained during this study indicates that HR-MRI better delineates intracranial arterial lesions, suggesting that its use will lead to a further understanding of the mechanisms involved in stroke.