RU2195671C2 - Method of differentially diagnosing hemorrhagic and ischemic insult - Google Patents

Abstract

FIELD: neurology. SUBSTANCE: when investigating cerebrospinal fluid, antibodies against basic myelin protein are revealed by means of immune-enzyme assay from optical density. In case, when average value of optical density coefficient is equal to 0.268+/-0.45, ischemic insult is diagnosed and, when this coefficient is equal to 0.44+/-0.35, hemorrhagic insult. EFFECT: increased accuracy of diagnostics and simplified procedure. 1 tbl, 2 ex

Description

 The invention relates to medicine, namely to neurology. Acute cerebrovascular accident (stroke) is a leading problem in clinical medicine, as it causes high mortality and severe disability of the population. According to the WHO, mortality from vascular pathology of the brain takes 3rd place after cardiovascular diseases and malignant neoplasms, and in a number of countries goes to 2nd place. Emergency diagnosis and emergency care for stroke is one of the most difficult and crucial tasks and needs to be further improved and improved, since the frequency of erroneous diagnoses for this pathology at the prehospital stage reaches 70%. For able-bodied people aged 25-64 years, the frequency of stroke is 1 case per 1000 inhabitants per year. Disability after a stroke is 3.2 per 10 thousand people, taking 1st place among all the causes of permanent disability.

There is a "Method for the differential diagnosis of hemorrhagic and ischemic stroke" (Copyright certificate 1596249 A1 dated 09.30.90, Bull. 36 T. F. Pirogova, G. I. Enin, L. G. Gornostaeva), which consists in the fact that the differential the diagnosis is carried out using a study of blood serum albumin and cerebrospinal fluid, followed by determination of the ratio of serum albumin to cerebrospinal fluid, and with a value of 60 or less, hemorrhagic stroke is diagnosed, and with a value of 110 or more, ischemic stroke. Some disadvantage, in the opinion of the authors, of the method is that it is quite expensive. Currently, differential diagnosis of ischemic and hemorrhagic stroke is carried out according to cerebrospinal fluid obtained as a result of lumbar puncture. This method is proposed by the authors as an analogue. With more than 25,000 er. in 1 μl - subarachnoid hemorrhage is diagnosed, with more than 1000 er. - intracerebral hemorrhage, but in 10% of cases, cerebrospinal fluid does not change. In the presence of 50 - 500 er. in 1 μl - embolism is more likely. However, these indicators may be "+". In the presence of "traveling" blood, with traumatic puncture, with embolism complicated by diapedetic impregnation. (Neurology. M: Medicine, 1998, p. 37. G. Weiner, L. Levitt.)
As a prototype, the authors propose the determination of antibodies to MBP, using ELISA, used to diagnose multiple sclerosis. (The journal "Immunology" 1986, 6, "Immunology" 1982, 3, "Questions of rheumatism" 1972, 1, "Multiple sclerosis". M: 1997 E.I. Gusev, G.L. Demina, A.N. Boyko. "Multiple Sclerosis". M.: 1987. O. A. Khondkarian, I. A. Vavalishin, O. M. Nevskaya). The authors offer their own way of differential diagnosis of hemorrhagic and ischemic stroke. Biochemical, immunological parameters in the cerebrospinal fluid and serum of patients were examined: AST, ALT, antiphoserolipids, antibodies to the myelin basic protein.

 For the differential diagnosis of hemorrhagic and ischemic stroke, the applicants suggest the study of antibodies to the myelin basic protein in the cerebrospinal fluid of patients with stroke, as the most obvious indicator. Liquor was climbed by lumbar puncture. After interaction with reagents diluted in distilled water, ELISA is carried out and ELISA results are taken into account by determining the optical density on a vertical spectrophotometer. Evaluation of the results is carried out by the difference between the average value of optical density (OD) and the average value of OP "K-", where OP is the optical density, "K-" negative serum is human serum containing antibodies to MBP below the diagnostic level.

 A total of 32 patients were examined (20 patients with ischemic stroke, 6 with hemorrhagic stroke, 6 people - the control group. ELISA of the cerebrospinal fluid was performed, the optical density was determined on the spectrophotometer. The results were evaluated by the difference in the average OD value - the average OD value "K- ". As a result of the study, it was reliably established that with an increase in antibodies to MBP compared with the control group, ischemic stroke is diagnosed 3 times, and with an increase of 5 times or more - hemorrhagic stroke.

 The survey results are presented in the table.

 The method presented by the authors is less time-consuming, improves the accuracy of differential diagnosis of ischemic and hemorrhagic stroke, performed in a hospital, does not require expensive equipment.

Clinical example:
1. Medical history 6683
Name - Chichkov V.N. , 59 years old.

 DS: Ischemic stroke in the left middle cerebral artery with right-sided hemiparesis.

 Study data: 0.277 (OD) antibodies to MBP on day 1.

2. Medical history 3871
Name - Makarov V.P., 68 years old.

 DS: Parenchymal-subarachnoid hemorrhage in the basin of the left middle cerebral artery, with right-sided hemiparesis, total aphasia.

 The performance of antibodies to MBP is 0.572 (OD).

Claims (1)

 A method for the differential diagnosis of hemorrhagic and ischemic stroke, including the study of cerebrospinal fluid, characterized in that antibodies to the main myelin protein (MBP) in the cerebrospinal fluid are determined using enzyme-linked immunosorbent assay by optical density, and diagnosed with an average optical density coefficient of 0.268 ± 0.45 optical units ischemic stroke, with an average value of 0.446 ± 0.35 optical units - hemorrhagic stroke.

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