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Table of Contents    
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1466

Biomarkers in Ischemic and Hemorrhagic Stroke

Department of Neurology, Institut of Neurosciences, Indraprastha Apollo Hospitals, New Delhi, India

Date of Submission24-Nov-2020
Date of Decision11-Jan-2021
Date of Acceptance15-May-2021
Date of Web Publication30-Oct-2021

Correspondence Address:
Pushpendra N Renjen
C-85, Anand Niketan, New Delhi - 110 021
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.329560

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How to cite this article:
Renjen PN, Chaudhari D. Biomarkers in Ischemic and Hemorrhagic Stroke. Neurol India 2021;69:1466

How to cite this URL:
Renjen PN, Chaudhari D. Biomarkers in Ischemic and Hemorrhagic Stroke. Neurol India [serial online] 2021 [cited 2021 Dec 7];69:1466. Available from:


There is an increased use of various stroke scales because of the growing interest in testing newer therapeutic agents for acute brain injury including brain infarction and brain hemorrhage. The usefulness of these need detailed evaluation. Edwards et al.,[1] in their study examined the middle cerebral artery neurological scale (MCANS) and the Scandinavian Neurological Stroke Scale (SNSS) together as the Unified Neurological Stroke Scale. The results of their study were used in the trials of ischemic and hemorrhagic stroke and it was found that the MCANS and SNSS scale had an acceptable level of reliability in distinguishing between ischemic and hemorrhagic stroke. Neuroimaging is the mainstay for differentiating between ischemic and hemorrhagic stroke. It is essential to perform CT and MRI to make a correct diagnosis. Recently the role of biomarkers has been evaluated to distinguish between hemorrhagic and ischemic stroke. Unfortunately, the present study by Bhatia et al.,[2] makes no mention of the role of the NT pro-BNP in differentiating cardioembolic and other stroke subtypes that have been mentioned in the literature. Our study[3] of 108 patients showed that the levels of NT pro-BNP were significantly higher in the cardioembolic group than in the non-cardioembolic group. To our mind, this is the only biomarker that has shown consistently good results and can be used as a clinical marker.

In the present study by Bhatia et al.,[2] it was suggested that S100 and IL 6 can be used for differentiating between ischemic and hemorrhagic stroke. The data for this is absolutely not convincing because the differentiating ability to differentiate between the 2 subtypes was low using the receiver operating characteristics (ROC) curve analysis. There is still not convincing evidence for the use of biomarkers in clinical practice, I would suggest good clinical examination, stroke scales, and neuroimaging are the gold standard till more robust evidence is available for other biomarkers.

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There are no conflicts of interest.

  References Top

Edwards DF, Chen YW, Diringer MN. Unified neurological stroke scale is valid in ischemic and hemorrhagic stroke. Stroke 1995;26:1852-8.  Back to cited text no. 1
Bhatia R, Warrier AR, Sreenivas V, Bali P, Sisodia P, Gupta A, et al. Role of blood biomarkers in differentiating ischemic stroke and intracerebral hemorrhage. Neurol India 2020;68:824-9.  Back to cited text no. 2
[PUBMED]  [Full text]  
Renjen PN, Beg MA, Chaudhari D, Singla R. Role of plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level in differentiating cardioembolic stroke from other stroke subtypes. Int J Sci Res 2017;6:206-209.  Back to cited text no. 3


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