PLASMA GFAP, D-DIMER AND SlOOB PROTEIN- A PANEL FOR DIFFERENTIAL DIAGNOSIS OF ACUTE CEREBROVASCULAR STROKE
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To explore the diagnostic utility of ghat fibrillar)? acidic protein (GFAP), S1000 protein and d-Dimer for differentiation between cases of acute cerebrovascular strokes compared to brain CT findings as a gold-standard diagnostic modality. Patients & Methods: The study included 80 patients; 51 males and 29 females with mean age of 49.616.8 years. Mean time lapsed since occurrence of symptoms till sampling was 8.3t-2.7; range: 2-12 hours. All patients underwent evaluation for clinical injury severity evaluation using the National Institute of Health Stroke Scale (MIMS'S), neuroimaging and venous blood samples were obtained once at admission for ELISA estimation of serum levels of GFAP, 5.100,8 protein and d-Dimer. Results: Radiodiagnosis of acute cerebrovascular strokes depended on brain CT alone in 54 patients; MRI alone 12 patientsand both CT and ME! in 9 patients and revealed intracranial hemorrhage (ICED in 12 patients, ischemic stroke (IS) in 31 patients, transient ischemic attack (7/4) in 19 patients and stroke mimic (S mimic) attack in 18 patients. Mean NIHSS score ofpatients had ICH was 13.3+-5.4, while was 11.6+-2.8 inpatients had IS and was significantly higher in patients had ICH andIS compared to TM and S mimic patients. Mean at admission plasma levels of S100 fi protein and GFAP were significantly higher in ICH patients compared to all other patients and in IS patients compared to those had TIA and S mimic with significantly higher plasma levels of GFAP and signtficantly lower SIOOft in TM compared to S mimic patients. Mean at admission levels of d-Dimer were significantly higher in IS patients compared to other patients' groups that showed non-significant inter-group difference. Stepwise regression and ROC curve analyses revealed that high GFAP and 510011 levels are specific predictors for ICH, while high GFAP and d-Dimer could differentiate between acute IS from S mimics and TM. Conclusion: High plasma levels ofGFAP and 510013 protein in association with short time lapsed till presentation and high clinical severity score could identify cases of hemorrhagic cerebrovascular stroke, while high plasma levels of d-Dimer and GFAP in association with high clinical severity score could identify cases of IS among cases of non-hemorrhagic stroke, so a panel of the three parameters; GFAP, d-Dimer and 810011 protein could be used as a differentiating modality among ases of acute cerebrovascular stroke and could be applied wherever neurot "ging facilities are unavailable or hazardous.