Serum S100B Predicts a Malignant Course of Infarction in Patients With Acute Middle Cerebral Artery Occlusion

Abstract

Background and Purpose-Early predictors of infarct volume may improve therapeutic decisions in patients with acute cerebral ischemia. We investigated whether measurements of serum astroglial protein S100B can predict a malignant course of infarction in acute middle cerebral artery (MCA) occlusion. Methods-We included 51 patients (24 women, mean age 69.1Ϯ12.4 years) admitted within 6 hours after stroke symptom onset caused by proximal MCA occlusion, as shown by magnetic resonance angiography (nϭ39), intra-arterial angiography (nϭ4), or transcranial duplex sonography (nϭ8). Blood samples were drawn at hospital admission and 8, 12, 16, 20, and 24 hours after symptom onset. Serum S100B concentrations were determined using a fully automated immunoluminometric assay. A malignant course of infarction was defined as the occurrence of clinical signs of cerebral herniation within the first 7 days of treatment or the clinical decision to perform decompressive hemicraniectomy caused by critical space-occupying swelling as detected by repeated neuroimaging. Results-Sixteen patients developed malignant infarction (31%). Beginning with the 12-hour value, mean S100B serum concentrations were significantly higher in patients with a malignant course compared with those without (

Blood Biomarkers of Ischemic Stroke

“…A biomarker to identify patients at risk for malignant cerebral infarction and to predict which patients benefit from such surgery would be useful. Indeed, S-100B predicts malignant infarction in patients with MCA occlusions [74]. A plasma level of S-100B >0.35 g/L predicted malignant infarction at 12 hours with a 75% sensitivity and 80% specificity, and at 24 hours with a 94% sensitivity and 83% specificity.…”

Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

“…At 24 hours, a value of 1.03 g/L has 94% sensitivity and 83% specificity for detection of malignant cerebral edema. 8 The availability of MRI in the acute period may allow for more precise volumetric analysis of the infarct. A MRI diffusion-weighted imaging volume of Ͼ82 cm 3 when performed Ͻ6 hours has a high specificity (98%) but low sensitivity (52%).…”

S100B and delirium in the geriatric acute care setting

“…Under normal conditions serum S100B levels are lower than that in cerebrospinal fluid (CSF). A second limitation is that only one blood sample is available during the 24 h period, and the half-life of S100B in the blood is less than 2 h, while Foerch et al [24] studied 51 elderly patients admitted within 6 hours after stroke symptom onset caused by proximal MCA occlusion. Serum S100B concentrations were determined at hospital admission and 8, 12, 16, 20, and 24 hours after symptom onset.…”

“…Serum S100B concentrations were determined at hospital admission and 8, 12, 16, 20, and 24 hours after symptom onset. Foerch et al [24] found that a 12-hour S100B value >0.35 µg/L predicted malignant infarction with 0.75 sensitivity and 0.80 specificity and a 24-hour value >1.03 µg/L provided 0.94 sensitivity and 0.83 specificity.…”