Summary
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Summary
The use of biomarkers in diagnosis of stroke, and as predictors of
stroke severity and prognosis is gaining particular attention in the recent
times. Neuron specific enolase (NSE) is one such biomarker; it is a
dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly
in the neurons and cells of the neuroendocrine system.
Various studies have shown a positive correlation between NSE
levels and infarct volume in patients of acute ischemic stroke, whereas
some studies have failed to demonstrate such relationship between NSE
levels and infarct volumes. Studies have also pointed out that there is a
significant correlation between NSE levels and stroke severity on
admission. On the other hand, few investigators have found no such
relationship between NSE levels and stroke severity at admission. The
ability of NSE levels to predict functional neurological outcome in stroke
patients is also a matter of recent interest with some studies suggesting
that NSE is useful in predicting functional outcome, while the other
studies suggesting otherwise.
In view of contradictory findings of these studies we conducted
this study on patients of acute ischemic stroke with the aims of
determining (1) the correlation between NSE levels at admission and
infarct volume. (2) Correlation between NSE levels at admission and
stroke severity. (3) Correlation between NSE levels at admission and
early functional neurological outcome.
Summary
105
This study was performed on 60 patients with ischemic stroke who
were admitted within24 hours of the onset of infarction and whose lesion
was confined according to neurological examination and computed
tomography (CT) or magnetic resonance imaging in neuropsychiatry
department at Benha University Hospital in the period between Mars
2014 and April 2015.
All subjects were submitted to the following:
1. Complete medical history.
2. Full neurological examination(including screening with modified
Rankin Scale)
3. Complete physical examination.
4. At least 1 or 2 CT scans of the brain or MRI.
5. Duplex scanning of carotid arteries.
6. 12-lead ECG, Trans thoracic echocardiography.
7. Routine laboratory investigations including complete blood count,
blood urea, creatinine , total cholesterol, triglycerides, glucose,
electrolytes, liver enzymes.
8. Serial samples will be analysed in 1st , 3rd and 10th dayes of
acute ischemic stroke using enzyme immunoassay.
Exclusion criteria:
1. Patients with history of recent clinical infection
2. Concurrent major renal or hepatic disease.
3. Concurrent cancerous or hemolytic diseases.
4. Signs and clinical evidence of in-hospital-acquired infection.
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106
5. Patients who had documented or clinical evidence of brain
infarction, haemorrhage, head trauma, or central nervous
system (CNS) infection within the 3 months before admission
NSE measurements:
In all patients the first NSE concentration (NSE 1) was measured
immediately after admission (within 12 hours after symptom onset).
The second NSE concentration (NSE 2) was done at the third day
after symptom onset,
and the third NSE (NSE 3) was evaluated one week after the
second measurement.
Outcome measurements:
The modified Rankin Scale was used to assess functional
disability and was evaluated at admission and at follow-up at 6 months
from stroke onset.
Results were tabulated and statistically analyzed:
¸ Among 60 patients included in the study; they were 38
males (63.6%) and 22 females (36.7 %).
¸ The mean value for modified Rankin scale and for age.
Themean Rankin Scale score was 3.62 The mean ± SD
age was 63.23.
¸ Hypertension was the most prevelant risk factor,45
patients (75%), followed by DM 27 patient (45%) then
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IHD 24 patient (40%), hypercholesterolemia 19 patients
(31.7%), 11 patients were smoker (18.3%), previous
stroke 10 patients (16.7%), 10 patients had previous TIA
(16.7%) ,8 patients had AF (13.3%), and 3 patients had
RHD (5%) .
¸ According to CT finding. 19 patients (31.7 %) had
cortical infarction, 30 patients (50 %) had subcortical
infarctions, 11 patient (18.3%) had cortical-subcortical
infarction .
¸ The level of NSE was highest in patients with corticalsubcortical
lesions (mean 82.00ng/ml) and lowest in
subcortical lesions (mean 47.97ng/ml) with cortical
lesions (mean 71.21ng/ml) in between .
¸ There was a linear correlation between NSE level and
mRS score. denoting that NSE has strong positive
correlation to functional outcome |
