Stroke

Cordonnier, Charlotte; Leys, Didier

doi:10.1136/jnnp.2008.149401

Cited by 9 publications

(9 citation statements)

References 8 publications

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“…It is important to distinguish between stroke subtypes and other mimics, such as migraine, focal epilepsy and structural brain lesions [9], which can account for up to a third of patients with stroke‐like symptoms [10]. Owing to its accessibility and speed, computed tomography (CT) has been the mainstay of stroke imaging.…”

Section: Introductionmentioning

confidence: 99%

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Hasan

McColgan

Bentley

et al. 2012

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTStroke is the largest single cause of disability in the UK. While tests based upon biomarkers have been around for decades, interest in the applications of biomarkers has increased greatly in recent years. Biomarkers released into the bloodstream following a stroke are useful not only for understanding the pathogenesis of stroke, but also play a significant role in the development of personalised medicine. The efficacy of current clinical models and imaging techniques for the diagnosis and prognosis of acute stroke could be improved when used in conjunction with blood biomarkers. While several studies have proposed a number of biomarkers associated with acute stroke in humans, there is conflicting information about the significance of implicated markers, and their clinical relevance is unclear. WHAT THIS STUDY ADDSIn an attempt to consolidate the plethora of data in this field, we have conducted a comprehensive systematic review and meta-analysis of proteomic and metabolomic blood biomarkers associated with acute stroke. Our meta-analysis has found eight biomarkers that are significantly associated with the diagnosis and prognosis of acute stroke. Interestingly we also found that CRP, a protein commonly implicated as a strong biomarker of inflammation and stroke, may not have sufficient sensitivity and specificity to be of clinical value, Thus while the biomarkers identified through our study are likely to be biologically informative about the mechanisms of vascular disease, their clinical potential for a blood-based test warrants further investigation. AIMSIdentification of biomarkers for stroke will aid our understanding of its aetiology, provide diagnostic and prognostic indicators for patient selection and stratification, and play a significant role in developing personalized medicine. We undertook the largest systematic review conducted to date in an attempt to characterize diagnostic and prognostic biomarkers in acute ischaemic and haemorrhagic stroke and those likely to predict complications following thrombolysis. METHODSA comprehensive literature search was carried out to identify diagnostic and prognostic stroke blood biomarkers. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for each biomarker. RESULTSWe identified a total of 141 relevant studies, interrogating 136 different biomarkers. Three biomarkers (C-reactive protein, P-selectin and homocysteine) significantly differentiated between ischaemic stroke and healthy control subjects. Furthermore, glial fibrillary acidic protein levels were significantly different between haemorrhagic stroke and ischaemic stroke patients (MD 224.58 ng l -1 ; 95% CI 25.84, 423.32; P = 0.03), high levels of admission glucose were a strong predictor of poor prognosis after ischaemic stroke and symptomatic intracerebral haemorrhage post-thrombolysis, glutamate was found to be an indicator of progressive (unstable) stroke (MD 172.65 mmol l -1 , 95% CI 130.54, 214.75; P = 0.00001), D-dimer predicted in-hospi...

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Section: Introductionmentioning

confidence: 99%

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Hasan

McColgan

Bentley

et al. 2012

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Stroke is a major health problem and associated with increased long-term mortality, residual physical, cognitive, and behavioral impairments, recurrence, and increased risk of other types of vascular event, such as myocardial infarction [10]. Eighty-eight percent of strokes have ischemic etiology; 8% to 12% of these ischemic strokes result in death within 30 days.…”

Section: Discussionmentioning

confidence: 99%

Effect of Atrial Fibrillation on Acute Ischemic Stroke Severity

Alloush¹,

Ibrahim²,

Ibrahim³

et al. 2014

OJMI

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Objectives: To assess the impact of atrial fibrillation on stroke severity and short-term (1 month) mortality. Materials and Methods: Totally 200 patients admitted to Ain Shams University Specialized Hospital were recruited and diagnosed clinically to have acute ischemic stroke within 3 days. Patients with hemorrhagic infarctions were excluded. History taking about previous heart disease was taken, full general and neurological examinations were done. Full metabolic profile, full cardiac investigations, carotid duplex, MRI brain stroke protocol with initial clinical evaluation and after 1 month re-evaluation using (NIHSS) scale. Results: All patients underwent transthoracic echocardiography which revealed absence of "A" wave corresponding to atrial fibrillation in 33 patients (16.5%). Those Patients with atrial fibrillation had a median NIHSS score of 11.00 with IQR of 6.00-18.50 at admission and 6.00 with IQR of 2.00-14.50 after one month. Patients with atrial fibrillation showed significantly higher NIHSS at admission than patients in sinus rhythm, P < 0.05. Magnetic resonance imaging findings showed that MRA showed significant intracranial vessel stenosis in 117 (79.1%) patients. 51 (34.4%) patients had lacunar infarction, 65 (43.9%) patients had partial anterior circulation infarction, 25 (16.2%) patients had posterior circulation infarction and 7 (4.7%) patients had total anterior circulation infarction. 111 (75%) patients showed leucoaraiosis. Conclusion: Atrial fibrillation was found not to have significantly statistical effect on stroke severity and short term mortality.

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“…Stroke is the most prevalent neurological disorder under the age of 85 years and 25% of males and 20% of females are expected to have stroke if they live up to this age. Patients with prevalent stroke and transient ischaemic attacks are the target for secondary prevention [11].…”

Section: Discussionmentioning

confidence: 99%

Effect of Heart Failure on Acute Ischemic Stroke Severity

Alloush¹,

Ibrahim²,

Ahmed³

et al. 2014

OJMI

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Objectives: To assess the impact of heart failure diseases on stroke severity and short term (1 month mortality). Materials and Methods: Totally, 200 patients admitted to Ain Shams university specialized hospital, were diagnosed clinically to have acute ischemic stroke within 3 days. History taking about previous heart disease was taken, and full general and neurological examinations were done. Full metabolic profile, cardiac examination and investigations were done. Carotid duplex, MRI stroke protocol and lastly clinical reevaluation using NIH Stroke Scale (NIHSS) after 1 month from stroke onset were done. Results: Patients with systolic dysfunction (EF ≤ 40%) had lacunar infarction in 18.75% of cases, partial anterior circulation infarction in 62.5% of cases, posterior circulation infarction in 6.25% of cases and total anterior circulation infarction in 12.5% of cases. Leucoaraiosis was present in 87% of cases and significant intracranial vessel stenosis was showed in 87.5% who had done MRI. Their median NIHSS score at admission was 10.5 with IQR of 5 -21 and at follow-up it was 5 with IQR of 2.5 -10.5. At follow-up 22.7% (5 patients) were dead. Conclusion: Systolic dysfunction (EF < 40) i.e. heart failure has no significant effect on stroke severity and 1 month follow up prognosis.

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Stroke

Cited by 9 publications

References 8 publications

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Effect of Atrial Fibrillation on Acute Ischemic Stroke Severity

Effect of Heart Failure on Acute Ischemic Stroke Severity

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