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ANTI-AGING
BIOMEDICINE.
HIGH TECH BIO-MEDICAL TECHNOLOGIES FOR DISEASE TREATMENT
AND LIFE EXTENSION.
EXPERIMENTAL AND CLINICAL DATA.
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Geneva Proteomics Center, Geneva
University Hospital, Geneva 14, Geneva 1211.
No biological marker is currently
available for the routine diagnosis of stroke. The
aim of this pilot study was to determine whether heart-fatty
acid binding protein (H-FABP) could be used as a valid
diagnostic biomarker for stroke, as compared to neuron
specific enolase (NSE) and S100B proteins. Using two-dimensional
gel electrophoresis (2-DE) separation of cerebrospinal
fluid (CSF) proteins and mass spectrometry techniques,
FABP was found elevated in the CSF of deceased patients,
used as a model of massive brain damage. Since H-FABP,
a FABP form present in many organs, is also localised
in the brain, an enzyme-linked immunosorbant assay
(ELISA) was developed to detect H-FABP in stroke vs.
control plasma samples. However, H-FABP being also
a marker of acute myocardial infarction (AMI), Troponin-I
and creatine kinase-MB (CK-MB) levels were assayed
at the same time in order to exclude any concomitant
heart damage. NSE and S100B levels were assayed simultaneously.
These assays were assessed in serial plasma samples
from 22 control patients with no AMI nor stroke, 20
patients with AMI but no stroke and 22 patients with
an acute stroke but no AMI. Twenty-two out of the
22 control patients and 15 out of the 22 stroke patients
were correctly classified, figures much better than
those obtained with NSE or S100B, in the same studys
population. H-FABP appears to be a valid serum biomarker
for the early diagnosis of stroke. Further studies
on large cohorts of patients are warranted.
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Department of Neurology, University
of Miami School of Medicine, FL, USA.
Pure motor neurologic deficits
occur among 3%-14% of all patients with ischemic stroke.
Pure motor monoparesis occurs among 2%-22% of patients
with pure motor stroke. The authors report the case
of a 73-year-old woman with isolated finger weakness
as the sole manifestation of a small cortical-subcortical
pure motor stroke diagnosed within 4 hours of onset
by means of diffusion-weighted echoplanar magnetic
resonance imaging. To the authors' knowledge, the
case of a patient with pure motor stroke with finger
weakness as the only manifestation has not been previously
reported. Increased awareness of this rare clinical
presentation of pure motor stroke coupled with the
promise of prompt diagnosis by means of diffusion-weighted
MRI should lead to earlier stroke intervention.
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Department of Internal Medicine,
Medical College of Ohio, Toledo 43699-0008, USA.
BACKGROUND: Accurate and timely
diagnosis of hemorrhagic and nonhemorrhagic strokes
helps in patient management. Neuroimaging studies
are useful in diagnosis and distinction of hemorrhagic
(HS) and nonhemorrhagic (NHS) strokes. The use of
clinical variables, such as Siriraj stroke scores
(SSS), has shown good sensitivity, specificity and
predictive values (distinguishing stroke types). The
aim of our study was to evaluate the use of SSS in
a U.S. population and assess whether it could aid
to expedite treatment decisions. METHODS: Levels of
consciousness, vomiting, headache and atheroma markers
used in SSS were applied to patients who met the criteria
for stroke. RESULTS: Of the 302 patients identified,
the SSS classified 254 with sensitivity of 36% (HS)
and 90% (NHS) and positive predictive values of 77%
and 61%, respectively. CONCLUSION: Our results suggest
that SSS is not reliable in distinguishing stroke
types (in a US population). Definite neuroimaging
studies are needed prior to thrombolytic therapy.
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Department of Radiology, Columbia-Presbyterian
Medical Center, New York, NY, USA.
In recent years there have
been formidable advances in the war against stroke.
The understanding and detection of stroke have undergone
major progress at a rate previously unseen, partly
due to major contributions from neuroradiology. Current
routine neuroradiologic evaluation of acute stroke
relies mainly on computed tomography scanning, although
a number of radiologic modalities are becoming available
that are based on various physical and chemical tissue
properties, such as magnetic resonance imaging, single
photon emission computed tomography, positron emission
tomography, and magnetic resonance spectroscopy. All
these new techniques allow the study of nervous tissue
at the cellular and biochemical levels. A review of
current diagnostic techniques for stroke follows in
the first part of this article. The current status
of endovascular therapy for ischemic stroke is reviewed
in the second part of this article.
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Department of Neurology, University
of New Mexico School of Medicine, Albuquerque.
To be consistent with a diagnosis
of TIA or stroke, a focal neurologic deficit must
have occurred suddenly. The differential diagnosis
of TIA includes migraine aura (possibly without a
headache), a hypotensive episode, radiculopathy, and
an unusual seizure. Vascular risk factors (eg, hypertension,
diabetes, smoking) and the extent of their control
should be determined. Cardiac examination and ECG
may provide important clues, as atrial fibrillation
and valvular heart disorders are well recognized potential
sources of emboli. During an acute stroke, CT is the
best test to reliably distinguish between ischemic
and hemorrhagic stroke. Other tests that may be indicated
on an individual basis include MRI,, echocardiography,
carotid duplex ultrasound, and arteriography.
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Clinica Neurologica, Perugia,
Italy.
OBJECTIVE--To compare two available
clinical scores for the differential diagnosis of
cerebral ischaemia and haemorrhage in acute stroke
patients. DESIGN--Prospective, multicentre study of
acute stroke patients evaluated with computed tomography
and Allen and Siriraj scores; the scores were tested
for comparability (kappa statistic) and validity (sensitivity,
specificity, positive and negative predictive values,
diagnostic gain). The effect of a policy of using
Allen and Siriraj scores to determine pathological
type of stroke before computed tomography was calculated.
SETTING--Three hospitals in Italy, all participating
in the international stroke trial, with different
access facilities to computed tomography. SUBJECTS--231
consecutive patients who were screened in the three
hospitals for possible inclusion in the international
stroke trial from 1 November 1991 to 31 May 1993.
RESULTS--The prevalence of haemorrhage (diagnosed
with computed tomography) was 14.7% (95% confidence
interval 10.1% to 19.3%). Allen scores were "uncertain"
in 44 cases and Siriraj scores in 38 cases; in the
164 cases with both the scores in the range of "certainty"
kappa was 0.72. Sensitivity, specificity, positive
and negative predictive values, and diagnostic gain
for haemorrhage were 0.38, 0.98, 0.71, 0.91, and 0.58
for Allen scores and 0.61, 0.94, 0.63, 0.93, and 0.48
for Siriraj scores; positive predictive values for
infarction were 91% for Allen scores and 93% for Siriraj
scores. According to these data, of 1000 patients
with acute stroke, 680 would be correctly and 70 wrongly
diagnosed as "ischaemic" with the Allen
score; the figures would be 671 and 48 with Siriraj
score. CONCLUSION--When computed tomography is not
immediately available and the clinician wishes to
start antithrombotic treatment (or randomise patients
in a clinical trial), the Siriraj score (and possibly
the Allen score) can be useful to identify patients
at low risk of intracerebral haemorrhage.
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