title: Stroke biomarkers in clinical practice: A critical appraisal.
abstract: Biomarkers provide critical mechanistic insights to key biologic processes that occur during cerebral ischemia which, when carefully applied, can improve clinical decision-making in acute stroke management. The translation of a blood-based biomarker in ischemic stroke to clinical practice is challenging, in part, due to the complexity of ischemic stroke pathogenesis and the presence of a blood-brain barrier that restricts the release of brain-specific markers into the circulation. The pathologic and clinical aspects of ischemic stroke are described in this review, where a non-exhaustive list of biomarkers that interrogate different aspects of ischemic stroke such as oxidative damage, inflammation, thrombus formation, cardiac function and brain injury are described. The potential roles of these biomarkers are further examined under different clinical scenarios aimed at (1) averting the risk of hemorrhagic transformation, (2) identifying individuals at risk of early neurologic deterioration and malignant infarction, (3) aiding in the diagnosis of ischemic stroke and its differentiation from other stroke mimics, (4) guiding the search for stroke etiology, and (5) assessing stroke risk within the community. Researchers should explore the roles of stroke biomarkers to enhance clinical decision-making that is presently largely based on intuition and subjective reasoning.
authors.affiliation: Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.
authors.forename: Geelyn J L
authors.initials: GJL
authors.lastname: Ng
authors.affiliation: Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.
authors.forename: Amy M L
authors.initials: AML
authors.lastname: Quek
authors.affiliation: Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
authors.forename: Christine
authors.initials: C
authors.lastname: Cheung
authors.affiliation: Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Thiruma V
authors.initials: TV
authors.lastname: Arumugam
authors.affiliation: Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore. Electronic address: raymond_seet@nuhs.edu.sg.
authors.forename: Raymond C S
authors.initials: RCS
authors.lastname: Seet
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D000066491:Clinical Decision-Making / Q000379:methods*; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D018384:Oxidative Stress / Q000502:physiology; D020521:Stroke / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators
keywords: Biomarkers; Etiology; Hemorrhagic transformation; Inflammation; Ischemic stroke; Oxidative damage