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Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 830-831

Blood Biomarkers are not an Alternative to Neuroimaging for the Early Diagnosis of Stroke

1 Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital Universitari del Sagrat Cor. Universitat de Barcelona, Barcelona, Catalonia, Spain
2 Library. Hospital Universitari del Sagrat Cor. Universitat de Barcelona, Barcelona, Catalonia, Spain

Date of Web Publication26-Aug-2020

Correspondence Address:
Dr. Adria Arboix
Unidad de Enfermedades Vasculares Cerebrales. Servicio de Neurologia, Hospital Universitari del Sagrat Cor., c/Viladomat 288, 08029 Barcelona. Catalonia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.293442

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How to cite this article:
Arboix A, Sánchez-López MJ. Blood Biomarkers are not an Alternative to Neuroimaging for the Early Diagnosis of Stroke. Neurol India 2020;68:830-1

How to cite this URL:
Arboix A, Sánchez-López MJ. Blood Biomarkers are not an Alternative to Neuroimaging for the Early Diagnosis of Stroke. Neurol India [serial online] 2020 [cited 2021 May 16];68:830-1. Available from:

Neuroimaging is the complementary examination of choice to differentiate cerebral hemorrhage from cerebral infarction. Although differences between both entities can be observed, both in the clinical manifestations and in the cerebral vascular risk factors, it is essential to perform a brain CT or brain MRI in order to discriminate them and make an adequate and correct diagnosis.[1] Even within the group of lacunar syndromes, caused in more than 80% of cases by lacunar-type cerebral infarctions, 3.8% of them can be caused by small subcortical cerebral hemorrhages, causing hemorrhagic lacunar strokes. Their clinical manifestations are indistinguishable from those caused by lacunar infarcts and their diagnosis can only be confirmed with neuroimaging techniques.[2]

It is essential to differentiate ischemic versus hemorrhagic stroke when planning early therapeutic goals, including thrombolysis, because acute stroke is an emergency whose treatment requires prior ruling out intracerebral bleeding.

Recently, the possible contribution of plasma biomarkers to the differential diagnosis between ischemia and cerebral hemorrhage has been analyzed.[3] Previously, higher levels of NT-proBNP have been observed in cardioembolic stroke, proving to be a promising and potentially useful biological data in the etiological diagnosis of this subtype of cerebral infarction.[4] However, there is still not enough evidence to suggest that isolated biochemical tests could differentiate ischemic stroke from other causes.

The study of Bathia et al. adheres to this line of clinical research.[1] The study was designed to test whether a panel of biomarkers could differentiate between ischemic and hemorrhagic strokes in the acute setting, in a sample of 250 consecutive patients with acute stroke (187 were ischemic and 63 had hemorrhagic stroke).

In their study, only S100 levels (higher among patients with hemorrhagic stroke) and Interleukin-6 levels (higher in patients with ischemic stroke) had a significantly discriminating ability to differentiate ischemic stroke and intracerebral hemorrhage. However, the overall discriminatory ability was low: using the receiver operating characteristic (ROC) curve analysis, the area under the curve for S100 was 65% and for IL6 was 59%, and the results revealed that the studied biomarkers were not sufficient for an accurate differential diagnosis of these entities. Therefore, the data were not robust to suggest routine clinical use.

In differentiating between ischemic and hemorrhagic strokes, the biomarker panel must raise, at least, specificity rates close to 100% to safely discard the possibility of administering thrombolysis to a patient with an intracerebral hemorrhage.[5] The accuracy rates of predictive models are still far from those requested in a real scenario. At this time, a rapid biochemical diagnosis of ischemic versus hemorrhagic stroke is not possible in the first hours after the onset of symptoms.

The discovery of new biomarkers with greater discriminatory capacity is necessary in the future for diagnostic use and remains the next challenge for achieving molecular diagnosis of stroke. Plasma biomarkers are now an interesting biological test, but not an alternative to neuroimaging for early diagnosis of stroke.

  References Top

Bhatia R, Warrier AR, Sreenivas V, Bali P, Sisodia P, Gupta A, Singh N, Padma Srivastava MV, Prasad K. Role of Blood Biomarkers in Differentiating Ischemic Stroke and Intracerebral Hemorrhage. Neurol India 2020;68:824-9.  Back to cited text no. 1
  [Full text]  
Arboix A, García-Eroles L, Massons J, Oliveres M, Targa C. Hemorrhagic lacunar stroke. Cerebrovasc Dis 2000;10:229-34.  Back to cited text no. 2
Bustamante A, López-Cancio E, Pich S, Penalba A, Giralt D, García-Berrocoso T, et al. Blood biomarkers for the early diagnosis of stroke. The Stroke-Chip study. Stroke 2017;48:2419-25.  Back to cited text no. 3
Arboix A, Alió J. Acute cardioembolic stroke: An update. Expert Rev Cardiovasc Ther 2011;9:367-79.  Back to cited text no. 4
Ng GJL, Quek AML, Cheung C, Arumugam TV, Seet RCS. Stroke biomarkers in clinical practice. A critical appraisal. Neurochem Int 2017;107:11-22.  Back to cited text no. 5


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