Indian Journal of Clinical Biochemistry

, Volume 33, Issue 2, pp 178–183 | Cite as

Role of Brain Biomarker in Predicting Clinical Outcome in Hypertensive Cerebrovascular Ischemic Stroke

  • Anuradha Bharosay
  • Vivek Vikram Bharosay
  • Kiran Saxena
  • Meena Varma
Original Article
  • 31 Downloads

Abstract

This study was undertaken to evaluate the role of serum neuron specific enolase (NSE) in prediction of disability and neurological worsening in hypertensive ischemic cerebrovascular stroke. 80 hypertensive ischemic stroke patients diagnosed by a neurologist as per WHO definition along with radiological findings suggestive of cerebrovascular stroke and differentiating from hemorrhagic stroke and 60 controls having essential hypertension coming to hospital because of regular checkup or headache but with no neurological disease were included in the study. Neurological disability was assessed by NIHSS at the time of admission (within 72 h from the onset of stroke) and on 7th day after admission and cases were categorized into mild, moderate and severe disability. Venous blood samples were drawn within 72 h from the onset of symptoms. The samples were processed as per the laboratory protocol. The serum NSE samples were analyzed using an enzyme immunoassay based on the sandwich technique. We observed raised serum NSE in hypertensive ischemic stroke (17.4 ± 5.4 ng/ml) with significant association between different hypertensive groups than in hypertensive controls (9.1 ± 0.75 ng/ml). Greater degree of disability was observed in hypertensive stroke patients with raised serum NSE and hypertensive patients with mean serum NSE level of 22.9 ± 3.6 ng/ml and dyslipidemia had greater probability of neurological worsening as compared to those with mean serum NSE level of 12.7 ± 1.2 ng/ml. Serum NSE levels can serve as a peripheral indicator of neuronal damage and assist in the prediction of disability and clinical outcome in hypertensive cerebrovascular ischemic stroke patients.

Keywords

Neuron specific enolase (NSE) National Institute of Health Stroke Scale (NIHSS) World Health Organization (WHO) International Society of Hypertension (ISH) 

References

  1. 1.
    Ohira T, Shahar E, Chambless LE, Rosamond WD, Mosley TH, Folsom AR. Risk factors for ischemic stroke subtypes: the Atherosclerosis Risk in Communities study. Stroke J Cereb Circ. 2006;37(10):2493–8.CrossRefGoogle Scholar
  2. 2.
    Al-Sarraf H, Philip L. Effect of hypertension on the integrity of blood brain and blood CSF barriers, cerebral blood flow and CSF secretion in the rat. Brain Res. 2003;975(1–2):179–88.CrossRefPubMedGoogle Scholar
  3. 3.
    Poulet R, Gentile MT, Vecchione C, Distaso M, Aretini A, Fratta L, et al. Acute hypertension induces oxidative stress in brain tissues. J Cereb Blood Flow Metab. 2006;26(2):253–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Ueno M, Sakamoto H, Liao Y-J, Onodera M, Huang C-L, Miyanaka H, et al. Blood-brain barrier disruption in the hypothalamus of young adult spontaneously hypertensive rats. Histochem Cell Biol. 2004;122(2):131–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Ishida H, Takemori K, Dote K, Ito H. Expression of glucose transporter-1 and aquaporin-4 in the cerebral cortex of stroke-prone spontaneously hypertensive rats in relation to the blood-brain barrier function. Am J Hypertens. 2006;19(1):33–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Gorelick PB, Aiyagari V. The management of hypertension for an acute stroke: what is the blood pressure goal? Curr Cardiol Rep. 2013;15(6):366.CrossRefPubMedGoogle Scholar
  7. 7.
    Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369(9558):293–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sotak CH. The role of diffusion tensor imaging in the evaluation of ischemic brain injury—a review. NMR Biomed. 2002;15(7–8):561–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Meric E, Gunduz A, Turedi S, Cakir E, Yandi M. The prognostic value of neuron-specific enolase in head trauma patients. J Emerg Med. 2010;38(3):297–301.CrossRefPubMedGoogle Scholar
  10. 10.
    González-García S, González-Quevedo A, Fernández-Concepción O, Peña-Sánchez M, Menéndez-Saínz C, Hernández-Díaz Z, et al. Short-term prognostic value of serum neuron specific enolase and S100B in acute stroke patients. Clin Biochem. 2012;45(16–17):1302–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Cronberg T, Rundgren M, Westhall E, Englund E, Siemund R, Rosén I, et al. Neuron-specific enolase correlates with other prognostic markers after cardiac arrest. Neurology. 2011;77(7):623–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Horn M, Seger F, Schlote W. Neuron-specific enolase in gerbil brain and serum after transient cerebral ischemia. Stroke J Cereb Circ. 1995;26(2):290–7.CrossRefGoogle Scholar
  13. 13.
    Gross J, Ungethüm U, Andreeva N, Heldt J, Priem F, Marschhausen G, et al. Glutamate-induced efflux of protein, neuron-specific enolase and lactate dehydrogenase from a mesencephalic cell culture. Eur J Clin Chem Clin Biochem J Forum Eur Clin Chem Soc. 1996;34(4):305–10.Google Scholar
  14. 14.
    Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke. 1989;20(10):1407–31.CrossRefGoogle Scholar
  15. 15.
    WHO. 1999 Guidelines for management of hypertension [Internet]. Cited 2016 Jul 14.Google Scholar
  16. 16.
    Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke J Cereb Circ. 1989;20(7):864–70.CrossRefGoogle Scholar
  17. 17.
    Goldstein LB. Blood pressure management in patients with acute ischemic stroke. Hypertension. 2004;43(2):137–41.CrossRefPubMedGoogle Scholar
  18. 18.
    Lisk DR, Grotta JC, Lamki LM, Tran HD, Taylor JW, Molony DA, et al. Should hypertension be treated after acute stroke? A randomized controlled trial using single photon emission computed tomography. Arch Neurol. 1993;50(8):855–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Casmiro M, Maitan S, De Pasquale F, Cova V, Scarpa E, Vignatelli L, et al. Cerebrospinal fluid and serum neuron-specific enolase concentrations in a normal population. Eur J Neurol. 2005;12(5):369–74.CrossRefPubMedGoogle Scholar
  20. 20.
    de Leeuw F-E, de Groot JC, Oudkerk M, Witteman JCM, Hofman A, van Gijn J, et al. Hypertension and cerebral white matter lesions in a prospective cohort study. Brain J Neurol. 2002;125(Pt 4):765–72.CrossRefGoogle Scholar
  21. 21.
    Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357.CrossRefPubMedGoogle Scholar
  22. 22.
    Henskens LH, van Oostenbrugge RJ, Kroon AA, Hofman PA, Lodder J, de Leeuw PW. Detection of silent cerebrovascular disease refines risk stratification of hypertensive patients. J Hypertens. 2009;27(4):846–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Golstein P, Kroemer G. Cell death by necrosis: towards a molecular definition. Trends Biochem Sci. 2007;32(1):37–43.CrossRefPubMedGoogle Scholar
  24. 24.
    González-Quevedo A, García SG, Concepción OF, Freixas RS, Sotolongo LQ, Menéndez MC, et al. Increased serum S-100B and neuron specific enolase—potential markers of early nervous system involvement in essential hypertension. Clin Biochem. 2011;44(2–3):154–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Johansson BB. Hypertension mechanisms causing stroke. Clin Exp Pharmacol Physiol. 1999;26(7):563–5.CrossRefPubMedGoogle Scholar
  26. 26.
    González-Quevedo A, González-García S, Hernández-Díaz Z, Concepción OF, Sotolongo LQ, Peña-Sánchez M, et al. Serum neuron specific enolase could predict subclinical brain damage and the subsequent occurrence of brain related vascular events during follow up in essential hypertension. J Neurol Sci. 2016;363:158–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Yokobori S, Hosein K, Burks S, Sharma I, Gajavelli S, Bullock R. Biomarkers for the clinical differential diagnosis in traumatic brain injury—a systematic review. CNS Neurosci Ther. 2013;19(8):556–65.CrossRefPubMedGoogle Scholar
  28. 28.
    Leonardi-Bee J, Bath PMW, Phillips SJ, Sandercock PAG, IST Collaborative Group. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33(5):1315–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Rodríguez-Yáñez M, Castellanos M, Blanco M, García MM, Nombela F, Serena J, et al. New-onset hypertension and inflammatory response/poor outcome in acute ischemic stroke. Neurology. 2006;67(11):1973–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Willmot M, Leonardi-Bee J, Bath PMW. High Blood Pressure in Acute Stroke and Subsequent Outcome. Hypertension. 2004;43(1):18–24.CrossRefPubMedGoogle Scholar

Copyright information

© Association of Clinical Biochemists of India 2017

Authors and Affiliations

  1. 1.Department of Biochemistry, Faculty of MedicineRoyal College of MedicineIpohMalaysia
  2. 2.Department of PathologyRoyal College of MedicineIpohMalaysia
  3. 3.Department of BiochemistryChirayu Medical CollegeBhopalIndia
  4. 4.Department of BiochemistrySri Aurobindo Institute of Medical SciencesIndoreIndia

Personalised recommendations