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(Stroke. 1998;29:258-260.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Serum Ferritin Concentrations Are Not Modified in the Acute Phase of Ischemic Stroke

Arola Armengou, MD; Antoni Dávalos, MD

Section of Neurology, Hospital Universitari Doctor Josep Trueta, Girona, Spain

José Manuel Fernandez-Real, MD

Section of Endocrinology, Hospital Universitari Doctor Josep Trueta, Girona, Spain

José Castillo, MD

Service of Neurology, Hospital Xeral de Galicia, Santiago de Compostela, Spain

To the Editor:

Three major molecular events in brain damage from cerebrovascular occlusion are at present the focus of interest: calcium overload, excessive acidosis, and enhanced production of free radicals. Free radicals are generated in increased amounts under ischemic conditions and react with and damage proteins, nucleic acids, and membrane lipids, disrupting cellular integrity.¹ This oxygen radical activity is especially intense during reperfusion after sustained ischemia. The generation of radical hydroxyl, the most toxic and reactive of free radicals, is catalyzed by ferrous iron released from intracellular stores during ischemia; thus, the sensitivity of neurons to oxidative stress depends on the availability of iron in the ischemic focus.^{2 3} Iron is released from large transport proteins, particularly from ferritin, which accounts for one third to three quarters of brain iron.⁴ In the absence of inflammation, cancer, and infectious diseases, the serum concentration of ferritin is thought to be directly proportional to tissue iron stores and can be used to assess their size.⁵

Despite the theoretical importance of iron in oxidative brain injury, very little direct evidence exists to implicate iron in stroke. In experimental models, iron depletion or chelation reduces ischemia-reperfusion–induced edema and metabolic failure.^{6 7} We found in 67 patients with acute ischemic stroke that high serum ferritin levels within the first 48 hours after stroke onset were associated with a poor prognosis, independent of the stress response.⁸ Using the same protocol, we have recently reproduced these results in a different and larger series of 103 patients (A. Dávalos, personal communication, . . . [Full Text of this Article]

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