Cognitive performance following spontaneous subarachnoid haemorrhage versus other forms of intracranial haemorrhage.

OBJECTIVE: The exact cause of cognitive deficits following intracranial haemorrhage is unclear. This prospective study examines the abilities after spontaneous subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH) and chronic subdural haematoma (SDH) to elucidate the cognitive outcome. PATIENTS AND METHODS: Ninety-nine patients with SAH (N = 60), ICH (N = 25), and SDH (N = 14) were followed up for an average of 6 and 12 months post-haemorrhage. Cognitive tests were used to examine attention, memory, concentration, and executive function. Following were used for analysis: 1. the percentage of patients falling below the 25th percentile per test, 2. the general development from the first to second test point and 3. the incidence of significant changes between the test points. Significance was established as p ≤ 0.05. RESULTS: All three types of haemorrhage resulted in deficits as concerns abstract language (53%-75%). The processing speed was below the normal levels in more than 70% of the patients tested. The cognitive performance of SAH patients was similar to that of patients with SDH and ICH patients after 6 months. The number of patients with outcomes falling below the 25th percentile (to some extent more than 75% in patients post-SAH) is high in all patient groups and mostly decreases over the course. Nevertheless, patients with SAH reveal improvements in many more areas than with ICH and SDH (p ≤ 0.006). CONCLUSIONS: The cognitive impairments following SAH, ICH and SDH deficits appear to develop in a similar way regardless of the type of haemorrhage. Cognitive improvement is most pronounced in patients with SAH.

A biochemical marker panel in MRI-proven hyperacute ischemic stroke-a prospective study.

BACKGROUND: Computer tomography (CT) is still the fastest and most robust technique to rule out ICH in acute stroke. However CT-sensitivity for detection of ischemic stroke in the hyperacute phase is still relatively low. Moreover the validity of pure clinical judgment is diminished by several stroke imitating diseases (mimics). The "Triage® Stroke Panel", a biochemical multimarker assay, detects Brain Natriuretic Peptide (BNP), D-Dimers (DD), Matrix-Metalloproteinase-9 (MMP-9), and S100B protein and promptly generates a Multimarkerindex of these values (MMX). This index has been licensed for diagnostic purposes as it might increase the validity of the clinical diagnosis to differentiate between stroke imitating diseases and true ischemic strokes. Our aim was to prove whether the panel is a reliable indicating device for the diagnosis of ischemic stroke in a time window of 6 h to fasten the pre- and intrahospital pathway to fibrinolysis. METHODS: We investigated all consecutive patients admitted to our stroke unit during a time period of 5 months. Only patients with clinical investigation, blood sample collection and MRI within six hours from symptom onset were included. Values of biochemical markers were analyzed according to the results of diffusion weighted MR-imaging. In addition MMX-values in ischemic strokes were correlated with the TOAST-criteria. For statistical analysis the SAS Analyst software was used. Correlation coefficients were analyzed and comparison tests for two or more groups were performed. Statistical significance was assumed in case of p < 0.05. Finally a ROC-analysis was performed for the MMX-Index. RESULTS: In total 174 patients were included into this study (n = 100 strokes, n = 49 mimics, n = 25 transitoric ischemic attacks). In patients with ischemic strokes the mean NIHSS was 7.6 ± 6.2, while the mean DWI-lesion volume was 20.6 ml (range 186.9 to 4.2 ml). According to the MMX or the individual markers there was no statistically significant difference between the group of ischemic strokes and the group of mimics. Moreover the correlation of the index and the DWI-lesion-volume was poor (p = 0.2). CONCLUSIONS: In our setting of acute MRI-proven ischemic stroke the used multimarker-assay (Triage® Stroke Panel) was not of diagnostic validity. We do not recommend to perform this assay as this might lead to a unjustified time delay.

Blood-based microcirculation markers in Alzheimer's disease-diagnostic value of midregional pro-atrial natriuretic peptide/C-terminal endothelin-1 precursor fragment ratio.

BACKGROUND: There is evidence that vascular factors contribute substantially to Alzheimer's disease (AD). We have developed assays to reliably detect the circulation and microcirculation regulating factors C-terminal endothelin-1 precursor fragment (CT-proET-1), midregional pro-adrenomedullin (MR-proADM), and midregional pro-atrial natriuretic peptide (MR-proANP). We hypothesized that this set of blood-based (micro)circulation parameters is altered in AD. METHODS: Prospectively recruited volunteer cohort (94 patients with probable AD, 53 healthy control subjects [HC]). In plasma, CT-proET-1, MR-proADM, and MR-proANP were analyzed using sandwich luminescence immunoassays. Concentrations of plasma markers and their ratios (MR-proANP/CT-proET-1 and MR-proADM/CT-proET-1) were compared between groups. Diagnostic accuracy of the vasodilator/vasoconstrictor ratios were calculated in the training set (half of AD and HC groups, respectively) and the optimal cutoff was then applied to the test set (remaining half of the study population). RESULTS: In AD patients, concentrations of MR-proADM and MR-proANP were significantly increased and levels of CT-proET-1 were significantly decreased compared with HC subjects. The ratios MR-proANP/CT-proET-1 and MR-proADM/CT-proET-1 improved group separation compared with the single markers. In a logistic regression analysis, the ratios of vasodilator/vasoconstrictor significantly contributed to group separation. The highest diagnostic accuracy was found for the MR-proANP/CT-proET-1 ratio. When applied to the training (test) set, specificity was 82% (80) and sensitivity was 81% (72). CONCLUSIONS: This indicates altered expression of microcirculation parameters and supports the hypothesis of a disturbed microvascular homeostasis in AD. We generated the hypothesis that the vasodilator/vasoconstrictor ratios hold promise as a diagnostic marker of AD. The best diagnostic accuracy was achieved for the MR-proANP/CT-proET-1 ratio.