Evaluation of CK MB levels in Acute Ischemic stroke

Stroke is a cerebrovascular event in which neurological deficit develops over minutes or hours, sometimes in a stepwise fashion, persists for 24 hours or more and is caused by a vascular disturbance such as arterial occlusion with consequent ischemic focal infarction of the brain. Various studies in these patients with stroke have shown to have myocardial injury. Electrocardiographic (ECG) abnormalities also have been observed in these patients but most cases do not show acute coronary artery disease. Cardiac enzymes like creatine kinase myocardial sub fraction (CK-MB) which are specific for myocardial infarction loses its specificity in patients with stroke. CK-MB levels elevation in these patients does not necessarily indicate any myocardial injury. 50 patients with acute ischemic stroke of first occurrence and 50 age matched controls without cardiac or neurological disease were assessed for CK-MB levels. ECG changes were also recorded. There was significant elevation of CK-MB levels in 28% of the patients compared to the controls. ECG changes were observed in 32% of patients. CK-MB elevation in acute ischemic stroke is likely due to non cardiac reasons. ECG changes do not correlate with elevation of CK-MB suggesting the possibility of insufficient sensitivity of ECG in detecting acute myocardial injury. Abnormally high levels of plasma catecholamine secondary to rapidly increasing intracranial pressure 12 , skeletal muscle injury caused by multiple injections 10 , negative caloric balance 10 may be the some of the reasons attributed to the elevation of CK-MB levels in these patients. Autonomic neural stimulation from hypothalamus or elevated circulating catecholamines are the mechanisms for ECG changes found in patients with stroke 21 .