Vanninen_EU Neurology 10/03/2010 10:16 Page 50
Brain Trauma Stroke
patients (58 ε4 carriers) with acute ischaemic stroke were In summary, the ApoE allele ε4 may have both some adverse and
prospectively studied. Neurofunctional status and functional some beneficial effects in patients with acute stroke. ApoE ε4 is
independence were not statistically different between ε4 carriers associated with increased vulnerability of the brain to the
and patients with the ε3/ε3 genotype. In agreement, Liu et al. in ischaemia, which is reflected in relatively greater lesion growth
their imaging study found that the neurological and functional and low threshold for the brain tissue to survive stroke and in
status at acute stage and at the three-month follow-up did not the lack of correlations between the imaging findings and
significantly differ between ε4 carriers and non-carriers, even clinical outcome in the ε4 carriers. On the other hand, ε4 has at
though the volume of infarcted tissue at acute stage was smaller least a seemingly beneficial effect on collateral blood flow, which
in ApoE ε4 carriers.
20
seems to be better in ε4 carriers compared with non-carriers.
In the clinical studies that focus on the relationship between
The detrimental effects of harbouring an ε4 allele can also be harbouring ε4 and clinical outcomes in ischaemic stroke patients,
observed in the patterns of correlations between imaging findings the adverse and beneficial effects may be compromised. In any
and neurological and functional status and outcome. Previous studies case, when possible, ApoE allele ε4 should be classified as
have suggested that the volume of infarction and haemodynamics at a confounding factor when studying stroke either by imaging
the acute stage of stroke significantly correlate with neurological and methods or clinically. n
functional status and outcome.
34–36
DWI lesions have even been
proposed as a part of an armoury to predict stroke recovery
37
and as
Yawu Liu is a Docent of Experimental Neuroradiology in
a surrogate marker of clinically meaningful lesion progression in
the Department of Clinical Radiology at the University of
stroke clinical trials.
38
Kuopio in Finland. His research interests include
imaging studies on stroke and dementia. He graduated
from Tianjin Medical University in China in 1990.
In a study with DWI and PWI, the measured infarct volumes did not
correlate with clinical outcome in the ε4 carriers, either initially or
during the follow-up. This was in stark contrast to the non-carriers, in
whom strong correlations between the imaging findings and clinical
Päivi Hartikainen is a senior specialist in neurology in
outcome were found. Similarly, in the ε4 carriers the imaging
the Department of Clinical Neurology at the University
parameters were not significantly correlated with clinical status, such Hospital of Kuopio. Her research interests include
as the NIHSS score at acute stage.
20 clinical studies related to neurodegenerative, drug and
stroke diseases.
Prediction of ischaemic lesion growth on the individual level is still
challenging,
24
and on the basis of the imaging studies mentioned
above it seems that such predictions would be especially challenging
Ritva L Vanninen is a Professor of Radiology in the
in individuals who are ε4 carriers. From the clinical point of view,
Department of Clinical Radiology at the University of
various predictive imaging markers are not reliable to show the Kuopio and Chief Radiologist at Kuopio University
clinical outcome profile of an individual patient. Although a well-
Hospital. Her research interests include imaging of
craniocervical arteries, acute stroke, subarachnoid
known confounding factor, ApoE ε4 cannot usually be taken into
haemorrhage, interventional neuroradiology and
account at the time of acute stroke to find out the best treatment neurodegenerative disorders. She has authored more
options or to control the possible side effects of treatments,
than 110 articles for peer-reviewed journals.
especially bleeding.
1. American Heart Association, International Cardiovascular 1999;53:1308–11. 26. Liu Y, Nuutinen J, Laakso MP et al., Acta Neurol Scand,
Disease Statistics, 2008. 14. Sudlow C, Martinez Gonzalez NA, Kim J, Clark C, Stroke, 2006;114:323–8.
2. Hassan A, Markus HS, Brain, 2000;123:1784–1812. 2006;37:364–70. 27. Plump AS, Smith JD, Hayek T et al., Cell, 1992;71:343–53.
3. Rubattu S, Giliberti R, Volpe M, Am J Hypertens, 15. Ariyaratnam R, Casas JP, Whittaker J, et al., PLoS Med, 28. Reddick RL, Zhang SH, Maeda N, Arterioscler Thromb,
2000;13:1139–48. 2007;4:e131. 1994;14:141–7.
4. Mahley RW, Rall SC, Jr, Annu Rev Genomics Hum Genet, 16. Banerjee I, Gupta V, Ganesh S, J Hum Genet, 2007;52:205–19. 29. Zhang SH, Reddick RL, Piedrahita JA, Maeda N, Science,
2000;1:507–37. 17. Laskowitz DT, Sheng H, Bart RD, et al., J Cereb Blood Flow 1992;258:468–71.
5. Helisalmi S, Linnaranta K, Lehtovirta M, et al., Neurosci Lett, Metab, 1997;17:753–8. 30. Weir CJ, McCarron MO, Muir KW, et al., Neurology,
1996;205:61–4. 18. Horsburgh K, Kelly S, McCulloch J, et al., Neuroreport, 2001;57:1097–1100.
6. Teasdale GM, Nicoll JA, Murray G, Fiddes M, Lancet, 1999;10:837–41. 31. McCarron MO, Nicoll JA, Neurosci Lett, 1998;247:45–8.
1997;350:1069–71. 19. Sheng H, Laskowitz DT, Bennett E, et al., J Cereb Blood Flow 32. Lemmens R, Gorner A, Schrooten M, Stroke,
7. Martinez-Gonzalez NA, Sudlow CL, J Neurol Neurosurg Metab, 1998;18:361–6. 2007;38:1185–8.
Psychiatry, 2006;77:1329–35. 20. Liu Y, Laakso MP, Karonen JO, et al., J Cereb Blood Flow Metab, 33. Vernooij MW, van der Lugt A, Ikram MA et al., Neurology,
8. Lanterna LA, Ruigrok Y, Alexander S, et al., Neurology, 2002;22:1336–42. 2008;70:1208–14.
2007;69:766–75. 21. McCarron M, Muir KW, Weir CJ, et al., Stroke, 34. Lövblad KO, Baird AE, Schlaug G et al., Ann Neurol,
9. Chowdhury AH, Yokoyama T, Kokubo Y, et al., J Epidemiol, 1998;29:1882–7. 1997;42:164–70.
2001;11:131–8. 22. McCarron MO, Muir KW, Nicoll JA et al., Arch Neurol, 35. Beaulieu C, de Crespigny A, Tong DC, et al., Ann Neurol,
10. Szolnoki Z, Somogyvari F, Kondacs A, et al., J Neurol, 2000;57:1480–84. 1999;46:568–78.
2002;249:1391–7. 23. Yonas H, Pindzola RR, Cerebrovasc Brain Metab Rev, 36. Kluytmans M, van Everdingen KJ, Kappelle LJ, et al.,
11. Pezzini A, Grassi M, Del Zotto E et al., Stroke, 1994;6:325–40. Eur Radiol, 2000;10: 1434–41.
2004;35:438–42. 24. Karonen JO, Liu Y, Vanninen RL et al., Radiology, 37. Warach S, Pettigrew LC, Dashe JF, et al., Ann Neurol,
12. Baum L, Ng HK, Wong KS et al., Clin Chem Lab Med, 2000;217:886–94. 2000;48:713–22.
2006;44:274–81. 25. Sorensen AG, Copen WA, Østergaard L et al., Radiology, 38. Baird AE, Dambrosia J, Janket S, et al., Lancet,
13. McCarron MO, Delong D, Alberts MJ, Neurology, 1999;210:519–27. 2001;357:2095–9.
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