Serial changes in plasma homocysteine in acute clinical stroke

Purpose The relationship between plasma homocysteine and stroke is controversial in many studies. There are only a few serial-sample studies which have looked at changes in stroke homocysteine during acute stroke. None of these studies investigated the changes in homocysteine in the first 3 days after stroke onset. Therefore, we designed this serial-sample prospective study to elucidate patterns of homocysteine concentration fluctuation at 0, 24 and 48 hours post stroke. Material and Methods Thirty one (22 ischemic and 9 hemorrhagic) patients with stroke and thirty three controls were selected. Three homocysteine levels were obtained from all stroke patients, while only one sample was taken from controls. Results Plasma homocysteine concentration was higher in males and in hemorrhagic stroke patients at all time points. Paired sample testing revealed significant differences in the mean values of homocysteine taken at 48 hours (p=0.047, 95% CI: −1.467 to −0.011) for all cases. For patients with hemorrhagic stroke, significant values were again obtained at 48 hours only (p=0.024, 95% CI:−8.266 to −0.763). After gender stratification, we found significantly higher mean homocysteine concentrations at all time points in male patients (at 0 hour: p=0.043, 95%CI: −5.197 to −0.908; after 24 hours: p=0.002, 95%CI: −7.899 to −2.279; after 48 hours: p=0.032, 95%CI: −4.644 to −0.246). Conclusions In this pilot study, we found that, on average, homocysteine levels initially decrease and then gradually rise in stroke patients, especially patients with hemorrhagic stroke. Also, there are significant genderbased differences in plasma homocysteine levels in our study population. In addition to increased levels of homocysteine after 48 hours in stroke patients, we found moderate hyperhomocysteinemia in our healthy controls, consistent with previous data from Pakistan.