title: Plasma homocysteine concentration, C677T MTHFR genotype, and 844ins68bp CBS genotype in young adults with spontaneous cervical artery dissection and atherothrombotic stroke.
abstract: OBJECTIVE
  The role of mild hyperhomocysteinemia as a risk factor for cerebral ischemia may depend on stroke subtype. To test this hypothesis, we undertook a prospective case-control study of a group of patients with spontaneous cervical artery dissection (sCAD), a group of patients with atherothrombotic stroke (non-CAD), and a group of control subjects.
  
  
  METHODS
  Fasting total plasma homocysteine (tHcy) concentration, C677T MTHFR genotype, and 844ins68bp CBS genotype were determined in 25 patients with sCAD, 31 patients <45 years of age with non-CAD ischemic stroke, and 36 control subjects. Biochemical data in the patient groups were obtained within the first 72 hours of stroke onset.
  
  
  RESULTS
  Median tHcy levels were significantly higher in patients with sCAD (13.2 micromol/L; range, 7 to 32.8 micromol/L) compared with control subjects (8.9 micromol/L; range, 5 to 17.3 micromol/L; 95% CI, 1.05 to 1.52; P=0.006). Cases with tHcy concentration above the cutoff level of 12 micromol/L were significantly more represented in the group of patients with sCAD compared with control subjects (64% versus 13.9%; 95% CI, 2.25 to 44.23; P=0.003); a significant association between the MTHFR TT genotype and sCAD was also observed (36% versus 11.1%; 95% CI, 1.10 to 19.23; P=0.045). No significant difference in tHcy levels and in the prevalence of thermolabile MTHFR was found between patients with non-CAD ischemic stroke and control subjects and between patients with sCAD and non-CAD ischemic stroke. The distribution of the 844ins68bp CBS genotype and the prevalence of subjects carrying both the TT MTHFR and 844ins68bp CBS genotypes were not significantly different among the 3 groups.
  
  
  CONCLUSIONS
  Our results are consistent with the hypothesis that increased plasma homocysteine levels and the TT MTHFR genotype may represent risk factors for sCAD. In contrast, their role in atherothrombotic strokes remains a contentious issue.
authors.affiliation: Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia. ale_pezzini@hotmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Del Zotto
authors.forename: Silvana
authors.initials: S
authors.lastname: Archetti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Negrini
authors.forename: Paolo
authors.initials: P
authors.lastname: Bani
authors.forename: Alberto
authors.initials: A
authors.lastname: Albertini
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.forename: Deodato
authors.initials: D
authors.lastname: Assanelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparotti
authors.forename: Luigi Amedeo
authors.initials: LA
authors.lastname: Vignolo
authors.forename: Mauro
authors.initials: M
authors.lastname: Magoni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
mesh_terms: D000328:Adult; D019943:Amino Acid Substitution; D002545:Brain Ischemia / Q000453:epidemiology / Q000235:genetics* / Q000378:metabolism; D020215:Carotid Artery, Internal, Dissection / Q000453:epidemiology / Q000235:genetics* / Q000378:metabolism; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005787:Gene Frequency; D005838:Genotype; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000453:epidemiology / Q000235:genetics; D007558:Italy / Q000453:epidemiology; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D000587:Oxidoreductases Acting on CH-NH Group Donors / Q000235:genetics*; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000235:genetics* / Q000378:metabolism; D020217:Vertebral Artery Dissection / Q000453:epidemiology / Q000235:genetics* / Q000378:metabolism
chemical_list: D006710:Homocysteine; D000587:Oxidoreductases Acting on CH-NH Group Donors; D042965:Methylenetetrahydrofolate Reductase (NADPH2)