title: The second elevation of neuron-specific enolase peak after ischemic stroke is associated with hemorrhagic transformation.
abstract: BACKGROUND
  Neuron-specific enolase (NSE) is a surrogate marker for the extent of brain damage after ischemic stroke and affords a good predictor of stroke prognosis. We hypothesized that the pattern of NSE level changes in the peripheral blood during the acute period of ischemic stroke is dependent on stroke mechanism and is associated with hemorrhagic transformation.
  
  
  METHODS
  Acute ischemic stroke patients visiting our center within 24 hours of symptom onset were recruited into the study. NSE levels were obtained serially at various time points after stroke, and the pattern of change was categorized into no significant change, continuously increasing, continuously decreasing, with 1 peak and with 2 peaks. Clinical, laboratory, and imaging variables were compared among the patient groups. Multivariate analysis was performed to verify the independent association between the second NSE peak and hemorrhagic transformation after adjusting for potential confounders.
  
  
  RESULTS
  Among 83 patients, NSE levels were stationary in 22 (26.5%) of the patients, increased in 9 (10.8%), decreased in 18 (21.7%), and showed 1 peak in 17 (20.5%) and 2 peaks in 17 (20.5%) patients. The incidence of atrial fibrillation and hemorrhagic transformation was significantly elevated (P = .02) in patients with 2 NSE peaks. Furthermore, the second NSE peak and the initial lesion volume were associated independently with hemorrhagic transformation after we adjusted for potential confounders (odds ratio = 6.844 and 1.024, P = .04 and .02, respectively).
  
  
  CONCLUSIONS
  Serial NSE analysis during the acute period of ischemic stroke is useful for monitoring hemorrhagic transformation and the blood-brain barrier disruption status.
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Bum Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Yeon-Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Na Young
authors.initials: NY
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea.
authors.forename: Jong S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, Seoul, Korea. Electronic address: sukwon@amc.seoul.kr.
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001812:Blood-Brain Barrier / Q000503:physiopathology; D002545:Brain Ischemia / Q000097:blood* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000097:blood* / Q000473:pathology*; D015912:Thrombolytic Therapy
chemical_list: D015415:Biomarkers; D010751:Phosphopyruvate Hydratase
keywords: Blood-brain barrier; hemorrhagic transformation; ischemic stroke; neuron-specific enolase; stroke mechanism