Published Online
on March 10, 2005

A more recent version of this article appeared on April 1, 2005

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Submitted on November 13, 2004
Revised on January 3, 2005
Accepted on January 27, 2005

Postacute C-Reactive Protein Levels Are Elevated in Cervical Artery Dissection

Just Genius MD; Tuan Dong-Si MD; Armin P. Grau MD; and Christoph Lichy MD^*

From the Department of Psychiatry (J.G., T.D.), Ludwig-Maximilian-Universität, Munich, Germany; Department of Neurology (A.G.), Städtisches Klinikum, Ludwigshafen, Germany; and Department of Neurology (J.G., C.L.), University of Heidelberg, Germany.

^* To whom correspondence should be addressed. E-mail: christoph_lichy{at}med.uni-heidelberg.de.

Background and Purpose--C-reactive protein (CRP) is associated with atherogenesis and stroke in mostly elderly subjects. We tested whether elevated CRP may also be linked to spontaneous cervical artery dissection (CAD) and cryptogenic stroke.

Methods--We investigated high-sensitivity CRP levels in 62 patients <60 years of age experiencing cerebral ischemia resulting from large artery atherosclerosis (LAA; n=21), CAD (n=21), or cryptogenic etiology (n=20) >9 months ago, and in 54 sex- and age-matched population controls. Receiver operating characteristic curve was used to identify the best CRP cutoff level for dichotomization.

Results--CRP was elevated above control levels (0.54 [0.33 to 0.84] median, interquartile range mg/L) in patients with LAA (2.59 [0.56 to 3.99] mg/L; P<0.001) and with CAD (2.37 [0.57 to 4.78] mg/L; P=0.0013) but not in patients with cryptogenic etiology (0.74 [0.14 to 7.86] mg/L). CRP levels above the cutoff level of 0.71 mg/L were independently associated with former CAD (P=0.005) but not with former LAA after adjustment for age, gender, and conventional risk factors.

Conclusion--Our results strongly suggest that CRP is associated with CAD, independent from conventional risk factors, and that inflammatory mechanisms may play a role in its pathogenesis. This finding should be confirmed by larger studies.

Key words: atherosclerosis • dissection • inflammation • stroke • young adults

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