Background: The rapid differentiation between intracerebral haemorrhage (ICH) and ischaemic stroke (IS) using biomarker testing would allow the prehospital, cause-specific management of stroke patients. Based on single measurements made during the acute phase of stroke, the value of serum glial fibrillary acidic protein (GFAP) was reported to be higher in ICH patients than in IS patients. The aim of the present study was to characterise the diagnostic window of serum GFAP for differentiating between ICH and IS. Methods: 63 stroke patients admitted within 6 h of symptom onset were prospectively included. ICH (n = 18) and IS (n = 45) were diagnosed using brain imaging. Blood sampling was scheduled for 1, 2, 3, 4, 6, 12, 24 and 48 h after stroke onset (if applicable), and serum GFAP was measured using an ELISA test. Results: For the first 24 h after stroke, median GFAP values in IS patients remained below the detection limit. Between 2 and 6 h of stroke onset, serum GFAP was significantly higher in ICH patients than in IS patients (p < 0.001 for all 4 time points). According to a receiver operating characteristic curve analysis, the overall diagnostic accuracy of GFAP in differentiating between ICH and IS was >0.80 within the 2- to 6-hour time window. Two hours after stroke onset, serum GFAP values were significantly correlated with ICH volume (r = 0.755, p = 0.007). Conclusions: The time window between 2 and 6 h after stroke onset is best for using GFAP to differentiate between ICH and IS. In the very early phase (i.e. <2 h), sensitivity for detecting ICH is low, thus hampering the application of GFAP as a near-patient test in the prehospital phase.

Eng LF, Ghirnikar RS, Lee YL: Glial fibrillary acidic protein: GFAP-thirty-one years (1969–2000). Neurochem Res2000;25:1439–1451.
Foerch C, Curdt I, Yan B, Dvorak F, Hermans M, Berkefeld J, Raabe A, Neumann-Haefelin T, Steinmetz H, Sitzer M: Serum glial fibrillary acidic protein as a biomarker for intracerebral haemorrhage in patients with acute stroke. J Neurol Neurosurg Psychiatry 2006;77:181–184.
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G: Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 1993;24:987–993.
Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T: Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med 1999;33:3–8.
Derex L, Adeleine P, Nighoghossian N, Honnorat J, Trouillas P: Factors influencing early admission in a French stroke unit. Stroke 2002;33:153–159.
Foerch C, Singer O, Neumann-Haefelin T, Raabe A, Sitzer M: Utility of serum GFAP in monitoring acute MCA territorial infarction. Cerebrovasc Dis 2003;16:45.
Herrmann M, Vos P, Wunderlich MT, de Bruijn CH, Lamers KJ: Release of glial tissue-specific proteins after acute stroke: a comparative analysis of serum concentrations of protein S-100B and glial fibrillary acidic protein. Stroke 2000;31:2670–2677.
Missler U, Wiesmann M, Friedrich C, Kaps M: S-100 protein and neuron-specific enolase concentrations in blood as indicators of infarction volume and prognosis in acute ischemic stroke. Stroke 1997;28:1956–1960.
Pelinka LE, Kroepfl A, Schmidhammer R, Krenn M, Buchinger W, Redl H, Raabe A: Glial fibrillary acidic protein in serum after traumatic brain injury and multiple trauma. J Trauma 2004;57:1006–1012.
Jung CS, Foerch C, Schanzer A, Heck A, Plate KH, Seifert V, Steinmetz H, Raabe A, Sitzer M: Serum GFAP is a diagnostic marker for glioblastoma multiforme. Brain 2007;130:3336–3341.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.