Abstracts

Rationale: We diagnose epileptic and acute symptomatic seizure from acute stroke in real clinical practice of neurological emergency. But it is sometimes difficult to differentiate these symptoms because of limited time and medical resource. Stroke neurologists have to consider the indication of thrombolytic therapy for acute ischemic stroke under the information of episode, neurological score and non-contrast computed tomography because the treatment require the decision as soon as possible for minimal damage of the brain. It often contains the risk of hemorrhagic complication and increase in severity, especially in the case of contraindication.The aim of this study was to examine serum lactate as a diagnostic marker of seizure in the patients of neurological emergency. Methods: We analyzed the data of consecutive 661 patients who were transported to our emergency department and treated. Serum lactate levels in blood samples drawn on arrival were compared retrospectively among patients with seizure, subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction and transient ischemic attack. Results: Serum lactate in patients with seizures and subarachnoid hemorrhages were significantly (p < 0.0001, Bonferroni test) increased in comparison to other groups. The area under the ROC-curve was 0.74 (95% CI 0.69-0.79). For a cut-off concentration of 2.50 mmol/l, the sensitivity was 0.63 and the specificity was 0.80.  Conclusions: Serum lactate levels in the acute diagnosis were an excellent biomarker for the discrimination of seizures from ischemic stroke. Combination use of computed tomography for the exclusion of subarachnoid hemorrhage enables to suspect seizure diagnosis, corroborating its importance for the standard work-up of neurological emergency.  Funding: None.