TITLE: The Utility of Plasma N- Terminal Brain Natriuretic Peptide (NT- Pro BNP) as a Biomarker to Differentiate Cardio embolic Stroke from Non-Cardio embolic Stroke.
PURPOSE: To measure plasma NT-Pro BNP in patients with acute ischemic stroke and investigate whether the plasma NT- pro BNP level can be a useful bio marker to differentiate cardio embolic (CE) stroke from non-cardio embolic (NCE) stroke or not.
STUDY DESIGN: In our analytic observational prospective study, 66 patients were enrolled within 24 hours of the onset of acute ischemic stroke and met inclusion and exclusion criteria.
METHODOLOGY: Plasma NT-pro BNP level was performed in each patient. Clinical observations were recorded on special performa designed for the study. They were classified in to four groups: Cardioembolic (CE), Large artery atherosclerosis (LAA), Small-vessel disease (SVD) and other subtypes according to TOAST classification. Study outcome was measured by applying appropriate statistical tests at the end of all patient enrolments.
RESULTS: Out of 66 patients, 21(31.81 %) were cardioembolic whereas 45 (68.18%) patients were in non-cardioembolic (NCE) group. The result showed that plasma NT pro BNP levels were significantly higher in CE group than NCE group (p value<0.001). The optimal cut off point for NT pro BNP levels to differentiate CE stroke from NCE stroke was > 594 pg./ml with 93.33% Specificity and 66.67% Sensitivity.
CONCLUSION: As plasma biomarker NT-pro BNP has a good sensitivity, specificity and accuracy for early identification of cardio embolic stroke.
An 18-year-old man with normal birth and development and a negative family history complained of nonprogressive clumsiness and posturing of his left hand since early childhood. His left limbs were shorter than his right but showed no evidence of atrophy (eFigure 1, A-C, links.lww.com/ WNL/B902). Examination revealed dystonic posturing with mirror dystonia of the left hand and subtle mirror movements in his feet (Video 1). MRI of the brain showed right hemiatrophy of the midbrain, bilateral cortical activation with unilateral finger taps on fMRI, and normal corticospinal tract decussation (Figure , A-F). Levodopa response was present, suggesting dopaminergic denervation due to a congenital hemi-midbrain insult. 1 This case represents hemidystoniahemiatrophy syndrome. 2 Subtle limb shortening and mirror dystonia can aid in diagnosis.
Study FundingNo targeted funding reported.
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