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(Stroke. 2001;32:2423.)
© 2001 American Heart Association, Inc.

Comments, Opinions, and Reviews

Early Stroke: A Dynamic Process

Gudrun Boysen, MD, MDSc Hanne Christensen, MD

From the Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

Correspondence to Gudrun Boysen, MD, Department of Neurology, Bispebjerg Hospital, 2400 Copenhagen, Denmark. E-mail gb01@bbh.hosp.dk

Key Words: stroke • stroke onset • stroke, acute

	Introduction

 
In the acutely infarcted brain, cytokines are released into cerebrospinal fluid and blood. Interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-, among others, may play a role in the acute increases in plasma adrenocorticotropic hormone, cortisol, epinephrine, norepinephrine, and vasopressin.^1–6 Increases in cytokines and hormones may in turn induce changes in other variables. When recorded on admission in acute stroke patients, many variables have been found to be associated with poor outcome in acute stroke. Body temperature⁷ is one such variable, blood glucose another,^8–18 and C-reactive protein (CRP)^19–22 and white blood cell count (WBC)^20,23 serum cortisol and ferritin²⁴ are further examples. Elevated plasma and cerebrospinal fluid levels of glutamate, glycine,²⁵ ferritin,²⁶ and IL-6²⁷ were also associated with deteriorating stroke.

It seems plausible that these variables generally are unaffected at stroke onset and then increase in the early hours after onset, depending on the severity of the stroke. We found this to be the case with temperature,²⁸ which in a large series of patients was normal when measured within 2 hours of stroke onset, but which rose at 4 to 6 hours after stroke onset in patients with severe neurological deficits. At 8 to 10 hours after stroke onset, elevated temperature was associated with poor outcome. This association arose several hours after onset of severe stroke. Thus, the initial severity of the stroke preceded the increase in temperature.

Many studies on blood glucose and stroke prognosis share the same kind of problem. In most studies, blood glucose was measured fairly . . . [Full Text of this Article]

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