Monday, December 28, 2009

Lactate as cause of secondary damage in acute ischemic stroke

Atherosclerosis of the carotid arteries is a leading cause of ischemic stroke. Increased carotid artery intima-media thickness (IMT) is a marker of atherosclerosis and also a predictor for ischemic stroke that represents more than 80% of strokes, with the remainder due to hemorrhage.
Recent study involving 187 patients with acute ischemic stroke or transient ischemic attack (1) have indicated that lactate in cerebrospinal fluid, but not in blood, is a reliable marker for the metabolic crisis in acute ischemic stroke and a possible cause of secondary neuronal damage in cortical infarction resulting in unfavourable evolution in the sub acute phase of stroke and poor long-term outcome.
However, some researchers believe that whole blood lactate, as measured in this study, unlike serum lactate, is an unreliable measure of systemic lactate (2).
It is interesting to note that a study from 2004 found ischemic stroke acidosis-mediated activation of acid-sensing ion channels may play a role to ischemic damage of brain tissue (3).
Most interesting is that cardiac glycosides, besides its anti-atherosclerotic effects as discussed recently in this blog (4, 5), also can provide cerebral neuroprotection in front of ischemic stroke and in prevention of its occurrence (6).

1) Evaluation of lactate as a marker of metabolic stress and cause of secondary damage in acute ischemic stroke or TIA, Brouns R, Sheorajpanday R, Wauters A, Surgeloose DD, MariĆ«n P, DE Deyn PP. Clinica Chimica Acta 397 (2008) 27–31
2) The Lactic Acid Response to Alkalosis in Panic Disorder: An Integrative Review Richard J. Maddock, M.D.J Neuropsychiatry Clin Neurosci 13:1, Winter 2001. Full free paper at
3) Huang Y, McNamara JO. 2004. "Ischemic Stroke: “Acidotoxicity” Is a Perpetrator", Cell, Volume 118, Issue 6 , 17 September, Pages 665-666
4) The anti-atherosclerotic effects of cardiac glycosides, Carlos Monteiro at
5) Carlos ETB Monteiro, Acidic environment evoked by chronic stress: A novel mechanism to explain atherogenesis. Available from Infarct Combat Project, January 28, 2008 at
6) Cardiac Glycosides in Prevention of Stroke, Carlos Monteiro, ICP, July 10, 2006, Full text at

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