Published Online
on August 5, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on March 5, 2004
Revised on May 31, 2004
Accepted on June 22, 2004

Serum S100B Predicts a Malignant Course of Infarction in Patients With Acute Middle Cerebral Artery Occlusion

Christian Foerch MD^*; Bettina Otto MD; Oliver C. Singer MD; Tobias Neumann-Haefelin MD; Bernard Yan MD; Joachim Berkefeld MD; Helmuth Steinmetz MD; and Matthias Sitzer MD

From the Department of Neurology (C.F., B.O., O.C.S., T.N.-H., H.S., M.S.) and the Institute of Neuroradiology (B.Y., J.B.), Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.

^* To whom correspondence should be addressed. E-mail: foerch{at}em.uni-frankfurt.de.

Background and Purpose--Early predictors of infarct volume may improve therapeutic decisions in patients with acute cerebral ischemia. We investigated whether measurements of serum astroglial protein S100B can predict a malignant course of infarction in acute middle cerebral artery (MCA) occlusion.

Methods--We included 51 patients (24 women, mean age 69.1±12.4 years) admitted within 6 hours after stroke symptom onset caused by proximal MCA occlusion, as shown by magnetic resonance angiography (n=39), intra-arterial angiography (n=4), or transcranial duplex sonography (n=8). Blood samples were drawn at hospital admission and 8, 12, 16, 20, and 24 hours after symptom onset. Serum S100B concentrations were determined using a fully automated immunoluminometric assay. A malignant course of infarction was defined as the occurrence of clinical signs of cerebral herniation within the first 7 days of treatment or the clinical decision to perform decompressive hemicraniectomy caused by critical space-occupying swelling as detected by repeated neuroimaging.

Results--Sixteen patients developed malignant infarction (31%). Beginning with the 12-hour value, mean S100B serum concentrations were significantly higher in patients with a malignant course compared with those without (12 hours 1.23±1.24 versus 0.29±0.45 µg/L; 16 hours 1.80±1.65 versus 0.38±0.53 µg/L; 20 hours 1.90±1.53 versus 0.44±0.48 µg/L; and 24 hours 2.41±1.59 versus 0.57±0.66 µg/L; all P<0.001). A 12-hour S100B value >0.35 µg/L predicted malignant infarction with 0.75 sensitivity and 0.80 specificity. A 24-hour value >1.03 µg/L provided 0.94 sensitivity and 0.83 specificity.

Conclusions--The serum marker S100B can predict a malignant course of infarction in proximal MCA occlusion. This finding may improve the identification and monitoring of patients at particularly high risk for herniation.

Key words: biological markers • brain edema • cerebral infarction • middle cerebral artery

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