Diagnostic Biomarkers for Stroke: A Stroke Neurologist’s Perspective

Abstract

Since 2003, four articles on stroke biomarkers as potential diagnostic tests have been published in Clinical Chemistry (1)(2)(3)(4). Each has described an initial foray into attempting to find a holy grail in clinical stroke—a blood test for stroke—and each has provided early exciting results that suggest that we may yet welcome a new era of stroke diagnostics into the clinical realm. Human stroke is remarkably heterogeneous. Stroke varies widely in severity with a majority of strokes being mild. Stroke comes in 3 major types. In North America and Europe, ischemic stroke comprises 85% of all strokes, intracerebral hemorrhage 8%, and subarachnoid hemorrhage 7%. These ratios differ in Asia with up to 30% of strokes occurring as intracerebral hemorrhages. For the neurologist, stroke is relatively easy to diagnose clinically. It is the most common cause of a sudden acute neurologic deficit in both adults and children. Imaging is the mainstay of identifying stroke type because it is not possible to distinguish ischemia from hemorrhage reliably on clinical grounds alone. A brain computed tomographic scan rules in an intracerebral hemorrhage or subarachnoid hemorrhage and in many cases …