PLASMA AND CEREBROSPINAL FLUID HOMOCYSTEINE, NITRIC OXIDE AND MALONDIALDEHYDE LEVELS IN ACUTE ISCHEMIC STROKE: POSSIBLE ROLE OF FREE RADICALS IN THE DEVELOPMENT OF BRAIN INJURY

Abstract

Aim: Free radical mechanisms may play an important role in brain ischemia / reperfusion injury. The generation of reactive oxygen species by homocysteine (Hcy) or nitric oxide (NO) metabolism might be involved in the induction of lipid peroxidation, as indicated by malondialdehyde (MDA) formation. The purpose of this study was to investigate the behavior of Hcy, NO and MDA in plasma and cerebrospinal fluid (CSF) within 4 days after ischemic stroke onset. Methods: The levels of NO, Hcy and MDA were determined in plasma and CSF on the 3rd or 4th days after the onset of ischemic stroke in 29 patients (12 men and 17 women) and in 13 healthy controls (6 men and 7 women) of comparable age and gender.Results: The plasma MDA, NO and Hcy levels were significantly higher in the stroke patients, while mean MDA, NO and Hcy levels in CSF showed a significant increase in the cases as compared to controls (p<0.01). There were no gender-specific differences in the plasma or CSF MDA, NO and Hcy concentrations. A significant negative correlation was found between duration of diabetes with CSF NO (r=-0.63, p<0.001). The low Glasgow Coma Scale (GKS) was negatively correlated with lethal outcome, (r=-0.76, p<0.001), but it did not correlate significantly with any of the measured parameters.Conclusion: These data support that free radical mechanisms may play a role in the development of brain injury following ischemic stroke. It was suggested that the elevated Hcy may be an important risk factor for acute ischemic cerebral injury.