Objectives: To explore the diagnostic utility of glial fibrillary acidic protein (GFAP), S100β protein and d-Dimer for dif
ferentiation between cases of acute cerebrovascular strokes compared to brain CT findings as a gold-standard diagnostic
modality.
Patients & Methods: The study included 80 patients; 51 males and 29 females with mean age of 49.6±6.8 years. Mean
time lapsed since occurrence of symptoms till sampling was 8.3±2.7; range: 2-12 hours. All patients underwent evaluation for
clinical injury severity evaluation using the National Institute of Health Stroke Scale (NIHSS), neuroimaging and venous blood
samples were obtained once at admission for ELISA estimation of serum levels of GFAP, S100β protein and d-Dimer.
Results: Radiodiagnosis of acute cerebrovascular strokes depended on brain CT alone in 54 patients, MRI alone 17 pa
tients and both CT and MRI in 9 patients and revealed intracranial hemorrhage (ICH) in 12 patients, ischemic stroke (IS) in
31 patients, transient ischemic attack (TIA) in 19 patients and stroke mimic (S mimic) attack in 18 patients. Mean NIHSS score
of patients had ICH was 13.3±5.4, while was 11.6±2.8 in patients had IS and was significantly higher in patients had ICH and
IS compared to TIA and S mimic patients. Mean at admission plasma levels of S100β protein and GFAP were significantly high
er in ICH patients compared to all other patients and in IS patients compared to those had TIA and S mimic with significantly
higher plasma levels of GFAP and significantly lower S100β in TIA compared to S mimic patients. Mean at admission levels
of d-Dimer were significantly higher in IS patients compared to other patients’ groups that showed non-significant inter-group
difference. Stepwise regression and ROC curve analyses revealed that high GFAP and S100β levels are specific predictors for
ICH, while high GFAP and d-Dimer could differentiate between acute IS from S mimics and TIA.
Conclusion: High plasma levels of GFAP and S100β protein in association with short time lapsed till presentation and high
clinical severity score could identify cases of hemorrhagic cerebrovascular stroke, while high plasma levels of d-Dimer and
GFAP in association with high clinical severity score could identify cases of IS among cases of non-hemorrhagic stroke, so a
panel of the three parameters; GFAP, d-Dimer and S100β protein could be used as a differentiating modality among cases of
acute cerebrovascular stroke and could be applied wherever neuroimaging facilities are unavailable or hazardous. |
