This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vila, N. Articles by Dávalos, A. Search for Related Content PubMed PubMed Citation Articles by Vila, N. Articles by Dávalos, A.

(Stroke. 2001;32:1234-a.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Glutamate, Interleukin-6, and Early Clinical Worsening in Patients With Acute Stroke

Nicolás Vila, MD Angel Chamorro, MD

ICMSN, IDIBAPS, Hospital Clinic, Barcelona, Spain

José Castillo, MD

Neurology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain

Antonio Dávalos, MD

Neurology Service, Hospital Universitario Doctor Josep Trueta, Girona, Spain

To the Editor:

We appreciate Dr Christensen’s interest in our work, recently published in Stroke.¹ As we stated in the Subjects and Methods section of that article, the 231 patients analyzed in our study were selected form a larger cohort of 249 patients admitted consecutively between October 1992 and December 1996. Shrewdly, Christensen correctly guesses that this larger cohort includes the 128 patients that supported our report on glutamate excitotoxicity in acute ischemic stroke.² Therefore, this larger series gives additional ground and further credit to the role of glutamate and IL-6 on neurological deterioration in patients with ischemic stroke.

The concentrations of glutamate in plasma (309.6±64.8 versus 106.3±49.3 µmol/L; P<0.0001) and CSF (13.3±3.8 versus 6.4±4.2 µmol/L; P<0.0001) were significantly higher in patients with clinical deterioration than in patients who remained stable or improved during the first 48 hours. Glutamate and IL-6 levels were positively correlated in samples of both plasma (Spearman coefficient 0.66, P<0.001) and cerebrospinal fluid (CSF) (Spearman coefficient 0.49, P<0.001). As shown in the Table, variables that remained independently associated with early clinical deterioration on multivariate analysis included IL-6 >21.5 pg/mL in plasma or >6.3 pg/mL in CSF, glutamate >200 µmol/L in plasma or >8.2 µmol/L in CSF, admission Canadian Stroke Scale score, and serum glucose.

View this table: [in this window] [in a new window]   Table 1. Factors Associated With Early Neurological Worsening

As pointed out by Dr Christensen, IL-6 has complex mechanisms of action that at present are not clearly understood. While we and others³ suggest proinflammatory properties in acute stroke, a . . . [Full Text of this Article]