Troponin in Stroke

Do you measure cTnI or cTnT routinely in your stroke patients? We do neither, yet we do obtain a  CRP or Na nearly daily. Is there any rationale behind this? Should you get troponins on your right sided insular lesions? And what if it is raised Рdo you have to order a cardiac workup? Do you give ASS and Clop to all these patients as for NSTEMIs?

Muddy waters… We are going to tread carefully, distinguishing between pre- and peristroke troponins, their role im identifying CHF and AF patients, the prestroke MI problem, the concept of neurocardiogenic disturbance (analogous to SAB) and what Tako-Tsubo has to do with it, and finally, we discuss the risk of peristroke MI and how to separate this entity from the rest, if possible.


Fever in stroke

Hypothermia in malignant MCA infarction in ICH is still a fascinating idea despite all the technical (and theoretical) problems the approach has. But we will not delve into this experimental approach but concentrate on the technically similarly problems of (near) normothermia and fever in stroke.
Nothing is known about this except that higher temperatures portend a bad outcome. We conclude (but have not proven) that we should lower raised temperatures. The means are legion (physical, drugs, cold infusions, CoolGard) but none have been properly examined. The only thing we know is that it is possible to establish a temperature management program. Whether this helps or not is unclear. Since we have one, we discuss it.
Most of what forms the basis of this discussion can be found in a recent article by the Erlangen gang (Kollmar et al) in this Cerebrovascular Disease 2011 article, which is free access by the way.