(Stroke. 1997;28:1951-1955.)
© 1997 American Heart Association, Inc.
Articles |
Endothelin in Cerebrospinal Fluid and Plasma of Patients in the Early Stage of Ischemic Stroke
From the Department of Neurology (Y.L., R. Gilad, I.S.-P.), E. Wolfson Medical Center, Holon, affiliated with the faculty of medicine, Tel Aviv University; the Department of Molecular Microbiology and Biotechnology (G.F.); and the Department of Neurobiochemistry (R. Galron, M.S.), The George Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel.
Correspondence to Yair Lampl, MD, Department of Neurology, Edith Wolfson Medical Center, Holon 58100, Israel.
Background and Purpose Endothelin 1 (ET-1), a highly potent endogenous vasoactive peptide, exerts a sustained vasoconstrictive effect on cerebral vessels. Elevation of ET-1 in plasma has been reported 1 to 3 days after ischemic stroke. Since we assumed that a much faster and more intense response may be observed in the cerebrospinal fluid (CSF) and since an increase in concentration of ET-1 in the CSF may cause constriction of cerebral vessels and eventually influence the neurological outcome, we measured ET-1 values in the CSF within 18 hours of stroke onset and compared the values with those in the plasma.
Methods Twenty-six consecutive patients with acute stroke were clinically evaluated according to the modified Matthew Scale and underwent two repeat CT scans. Within 5 to 18 hours of stroke onset, lumbar puncture and blood samples were concomitantly obtained and tested; ET-1 levels in CSF and plasma of these patients were analyzed by radioimmunoassay and compared with the levels of a control group of patients with no neurological disease.
Results The mean CSF concentration of ET-1 in the CSF of stroke patients was 16.06±4.9 pg/mL, compared with 5.51±1.47 pg/mL in the control group (P<.001). It was significantly higher in cortical infarcts (mean, 17.7±4.1 pg/mL) than in subcortical lesions (mean, 10.77±4.1 pg/mL) (P<.001) and significantly correlated with the volume of the lesion (P=.003). The correlation between ET-1 levels in the CSF and the Matthew Scale score was less significant (P=.05). Plasma ET-1 level was not elevated in any group.
Conclusions ET-1 is found to be significantly elevated in the CSF of stroke patients during the 18 hours after stroke. No elevation was demonstrated in plasma at this time period. ET-1 may be used as an additional indicator of ischemic vascular events in the early diagnosis of stroke. The dissimilarity between the CSF and plasma ET-1 concentrations may lead also to an hypothesis that there is a vasoconstrictive effect on the cerebral vessels or a neuronal effect caused by ET-1 in the mechanism of the progression of brain ischemia.
Key Words: endothelins • stroke, acute • cerebrospinal fluid • diagnosis
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