Body iron stores and early neurologic deterioration in acute cerebral infarction

Background: Iron-dependent free radicals formation has been related to grea ter damage in cerebral ischemia. The authors analyzed whether increased bod y iron stores were associated with early neurologic worsening and excitator y amino acid release in patients with acute ischemic stroke. Methods: Ferri tin, total iron, and glutamate concentrations in plasma and CSF were measur ed on admission in 100 consecutive patients with a cerebral infarction of < 24 hours' duration. The authors diagnosed progressing stroke when the Canad ian Stroke Scale score decreased one or more points between admission and 4 8 hours. Cranial CT was performed on admission and repeated on days 4 to 7 of hospitalization. Results: Ferritin concentrations in plasma (median 391, range 119 to 500 versus 148, 21 to 399 ng/mL) and in CSF (17.4, 6.8 to 82, versus 4.8, 0.6 to 14 ng/mL) were significantly higher in the 45 patients with subsequent progressing stroke than in those with nonprogressing stroke (p < 0.001). There was a positive correlation between ferritin and glutama te concentrations in plasma (r = 0.81, p < 0.001) and CSF (r = 0.64, p < 0. 001). Plasma ferritin concentrations >275 ng/mL in plasma (OR, 33.5; 95% CI , 4.7 to 235) and >11 ng/mL in CSF (OR, 11.4; 95% CI, 3.1 to 41) were indep endently and significantly related to early neurologic worsening. The effec t was reduced by >60% after controlling for glutamate concentrations, but r emained significant. Conclusions: High plasma and CSF ferritin concentratio ns within the first 24 hours from the onset of ischemic stroke are associat ed with early neurologic deterioration. Increased body iron stores may cont ribute to stroke progression by enhancing the cytotoxic mechanisms in cereb ral ischemia.