Interesting article in Lancet,
(Thanks to Bill Tomko)
SIMPLE LAB TEST MAY TELL IF STROKE WILL GET WORSE
About 25-50% patients admitted to hospital with stroke will get worse. No one is certain why strokesprogress in this way, and currently there is no way to predict which patients are at risk. However, in this week's Lancet, a team of Spanish researchers suggest that these patients may be identified before their stroke progresses with a simple blood test. Such a test would allow doctors to treat these
patients more aggressively and perhaps protect them from further damage.
The test measures the concentration of an aminoacid called glutamate which is stored in brain cells and used as a neurotransmitter. Many researchers believe that when stroke-damaged brain cells die
they can release such large amounts of glutamate that nearby cells, initially spared in the stroke, are "poisoned". This reaction could explain stroke progression.
In the experiment, Dr Jos‚ Castillo and Dr Manuel Noya from Santiago de Compostela, Spain and Dr Antoni D valos from Girona, Spain followed up 128 patients who were admitted to hospital for stroke. On admission to hospital, the researchers ranked the severity of each patient's neurological injury with a standard stroke-severity scoring system. They also measured the concentrations of glutamate and another aminoacid, glycine, thought to be involved in the glutamate reaction, in blood and cerebral spinal fluid. After 48 hours, the patients were re-evaluated. In 43 of the 128 patients the strokes had progressed.
The researchers found that in those 43 patients, glutamate and glycine concentrations were significantly higher. Plasma glutamate, however, appeared to be the best marker and it is the easiest to test for. The authors decided that if they had made a plasma glutamate concentration of more than 200 æmol/L the cut-off point, they would have been able on the first day of hospitalisation to identify four out of five of those patients whose strokes would get worse.
The researchers conclude that glutamate does play a key role in stroke progression and that plasma glutamate levels may be a useful test to guide doctors treating patients with stroke.
Contact: Dr Antoni D valos, Section of Neurology, Hospital Universitari Doctor Josep Trueta,Girona, Spain; tel +34 72 202 700 ext 282. |
