Leukocyte Biomarkers for the Differential Diagnosis of Mild Acute Ischemic Stroke, Transient Ischemic Attack, and Stroke Mimic

Abstract

Introduction The differential diagnosis of transient ischemic attack (TIA) versus mild acute ischemic stroke (AIS) during the initial presentation to the emergency department is often difficult, as the diagnosis of both TIA and AIS relies on the presence of focal neurologic signs. As such, roughly 50% of patients with transient or mild neurologic deficits have an uncertain diagnosis prior to neuroimaging. Biomarkers, particularly leukocyte biomarkers, may be used by clinicians to diagnose mild AIS prior to neuroimaging, and this study is the first to describe the use of leukocyte biomarkers for the differentiation of mild AIS, TIA, and stroke mimic. Methods We performed a retrospective chart review of patients discharged from a local hospital with a discharge diagnosis of either TIA or AIS. Past medical history and complete blood cell count with differential upon admission were collected for all subjects. Statistical analyses were performed to compare immune cell parameters between the two groups. For all comparisons, logistic regression analysis was used to assess the effect of confounding variables, such as age, gender, and medical history for each study variable. Results Of all the immune parameters assessed in this study, the neutrophil percentage was the only significant biomarker that significantly differed between study groups. After adjustment for confounding variables using stepwise logistic regression, mild AIS patients were 5.3 times more likely than TIA cases to have a neutrophil percentage above the normal range. Conclusion Our results suggest that clinicians may utilize neutrophil percentage as an additional piece of information that may aid in their diagnosis of mild AIS versus TIA.

Circulating Soluble CD163: A Potential Predictor for the Functional Outcome of Acute Ischemic Stroke

“…Previous studies suggest that the AIS-associated inflammatory component is partly driven by the myeloid immune compartment, including microglia, peripheral monocytes, and macrophages ( 16 ). Numerous studies identified alterations in immune biomarkers in the cerebral spinal fluid (CSF) and blood that are associated with the severity and prognosis of AIS ( 17 ). However, few of these biomarkers are cell type-specific and thus provide limited information on cellular relevance in the pathogenesis of AIS.…”

Body fluids biomarkers associated with prognosis of acute ischemic stroke: progress and prospects

“…Prior to this, people's interest in body fluid biomarkers for AIS mainly focused on diagnosis [ 9 , 10 ] and disease progression [ 11 , 12 ], but there was a lack of summary of prognostic-related body fluid biomarkers. It is worth noting that significant progress has been made in recent years in predicting neurological outcome, mortality, and post-stroke depression based on early body fluid biomarkers of AIS.…”