Introduction: Hyperhomocysteinemia is a well known vascular risk factor. However its action mechanism and its role in the acute phase of stroke have not been determined.
Objectives: To study plasmatic homocysteine levels in the acute stroke of different etiologies and evaluate its role as a prognostic factor.
Methods: We determined plasmatic homocysteine in 136 consecutive patients with stroke. Mean time from symptoms onset was 4.6 hours.
Results: Higher than normal homocysteine levels were found in ischemic stroke (n= 119 13.1 micromol/l; 43 % of patients > normality rank) and intracranial hemorrhage (n= 17 micromol/l; 24 % of patients > normality rank). The etiological distribution of ischemic stroke was the following: 42 cardioembolic (29.4%; median Hcy: 13.1 micromol/l), 20 atherothrombotic (14 %; Hcy: 12.7 micromol/l), 33 lacunar (23.1 %; Hcy: 11.8 micromol/l) and 24 undetermined (16.8%; Hcy:15.2 micromol/l). No significant differences were found between these groups (p=0.19). Those patients who presented early neurological deterioration presented higher homocysteine levels than those who remained stable or improved (median 13.3 n=16 v 11.3 n=113; p=0.061).
Conclusions: High homocysteine levels are associated to all etiologic stroke subtypes and intracranial hemorrhage. Patients who experienced early neurological worsening tend to have higher homocysteine levels.