Related Experiment Video
Updated: Jun 24, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
[Acute ischemic stroke and troponin elevation: update of the Mannheim clinical algorithm]
Louisa Becker1, Angelika Alonso1, Mathieu Kruska2
1Neurologische Klinik, Universitätsmedizin Mannheim (UMM) und Mannheim Center for Translational Neurosciences (MCTN), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
Insights
About half of acute ischemic stroke (AIS) patients have elevated high-sensitivity cardiac troponin (hs-cTn) levels, increasing cardiac risks. A standardized algorithm and expert collaboration are crucial for diagnosing diverse causes of troponin elevation in AIS.
Area of Science:
- Cardiology
- Neurology
- Biochemistry
Context:
- Elevated high-sensitivity cardiac troponin (hs-cTn) is common in acute ischemic stroke (AIS).
- These patients face increased risks of morbidity and mortality, often cardiac-related.
- Identifying the cause of hs-cTn elevation is critical for appropriate management.
Purpose:
- To present a practice-oriented approach for the differential diagnosis of hs-cTn elevation in AIS patients.
- To update the Mannheim clinical algorithm for managing troponin elevation in acute ischemic stroke.
- To emphasize the need for a multidisciplinary approach involving cardiologists and neurologists.
Summary:
- Approximately 50% of AIS patients exhibit elevated hs-cTn levels.
- Most hs-cTn elevations in AIS are due to non-ischemic myocardial injury.
- Causes are diverse, sometimes silent, and can include life-threatening conditions like myocardial infarction.
Impact:
- Facilitates accurate diagnosis and timely intervention for cardiac complications in AIS.
- Improves patient outcomes by guiding appropriate work-up and treatment strategies.
- Provides a standardized clinical algorithm for healthcare professionals managing AIS patients with elevated troponin.
Abstract:
Elevated high-sensitivity cardiac troponin (hs-cTn) levels should be expected in about half of all patients with acute ischemic stroke (AIS). Since those patients are at risk of increased morbidity and mortality, often attributable to cardiac causes, an adequate work-up of the underlying etiology is required. This can only be achieved by a team of cardiologists and neurologists. Since underlying causes of hs-cTn elevation in AIS patients are diverse, often atypical or silent in their clinical presentation and some, such as an accompanying myocardial infarction, can be acutely life-threatening, the work-up should follow a standardized clinical algorithm. The vast majority of hs-cTn elevations are caused by non-ischemic myocardial injury associated with AIS. This work presents a practice-oriented approach to differential diagnosis with the update of the Mannheim clinical algorithm for acute ischemic stroke and troponin elevation.
