Research Article| Volume 217, ISSUE 2, P175-180, February 15, 2004

Download started.


Serum-cortisol reflects severity and mortality in acute stroke


      Background: The adrenal glucocorticoid stress response in humans causes catabolism, increasing blood glucose and heart rate, and possibly potentiates ischaemic damage to neurons. These effects could induce secondary brain damage in acute stroke. Materials and Methods: This prospective study was based on a single determination of s-cortisol in 172 patients included within 24 h of stroke onset, 50% within 12 h of stroke onset. All patients were admitted to hospital within 6 h of stroke onset. We investigated the relations of s-cortisol to neurological deficit measured by Scandinavian Stroke Scale (SSS), lesion volume on CT-scan, blood glucose on admission, pulse rate, blood pressure, body temperature, deteriorating stroke, cytokines and cytokine receptors, and outcome. Results: In a multivariate logistic regression analysis, s-cortisol was independently related to death within 7 days of stroke onset, odds ratio (OR) Cortisol+100 nmol/l 1.9 (95% CI 1.01–3.8); serum-cortisol was, however, not a predictor of death or dependency within 3 months. S-cortisol correlated to SSS (ρ=−0.45, p<0.001), body temperature (ρ=0.27, p<0.001), pulse rate (ρ=0.26, p<0.001), and lesion volume (ρ=0.33, p<0.001). S-cortisol was related to the presence of insular damage. Conclusion: Acute stroke mortality related to increasing serum-cortisol levels. S-cortisol was associated with stroke severity and markers reflecting stroke severity.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Oka M.
        Effect of cerebral vascular accident on the level of 17-hydroxycorticosteroids in plasma.
        Acta Scand. Med. 1956; 156: 221-226
        • Feibel J.H.
        • Hardy P.M.
        • Campbell G.C.
        • Goldstein M.N.
        • Joynt R.J.
        Prognostic value of the stress response following stroke.
        JAMA. 1977; 238: 1374-1376
        • Myers M.G.
        • Norris J.W.
        • Hachinski V.C.
        • Sole M.J.
        Plasma norepinephrine in stroke.
        Stroke. 1981; 12: 200-204
        • Meyer J.S.
        • Stoica E.
        • Pascu I.
        • Shimazu K.
        • Hartmann A.
        Chatecholamine concentrations in CSF and plasma of patients with cerebral infarction and haemorrhage.
        Brain. 1973; 96: 277-288
        • Olsson T.
        Urinary free cortisol excretion shortly after ischaemic stroke.
        J. Int. Med. 1990; 228: 177-181
        • Murros K.
        • Fogelholm R.
        • Kettunen S.
        • Vuorela A.L.
        Serum cortisol and outcome of ischemic brain infarction.
        J. Neurol. Sci. 1993; 116: 12-17
        • Fassbender K.
        • Schmidt R.
        • Mossner R.
        • Daffertshofer M.
        • Hennerici M.
        Pattern of activation of the hypothalamic–pituary–adrenal axis in acute stroke. Relation to acute confusional state, extend of brain damage, and clinical outcome.
        Stroke. 1994; 25: 1105-1108
        • O'Neill P.A.
        • Davies I.
        • Fullerton K.J.
        • Bennett D.
        Stress hormone and blood glucose response following acute stroke in the elderly.
        Stroke. 1991; 22: 842-847
        • Christensen H.
        • Boysen G.
        Blood glucose increased early after stroke onset. A study on serial measurements.
        Eur. J. Neurol. 2002; 9: 297-301
        • Slowik A.
        • Turaj W.
        • Pankiewicz J.
        • Dziedziz T.
        • Szermer P.
        • Szczudlik A.
        Hypercortisolemia an acute stroke is related to the inflammatory response.
        J. Neurol. Sci. 2002; 196: 27-32
        • Johansson Å
        • Ahrén B.
        • Näsman B.
        • Carlström K.
        • Olsson T.
        Cortisol axis abnormalities early after stroke—relationships to cytokines and leptin.
        J. Int. Med. 2000; 247: 97-187
        • Chrousos G.P.
        The hypothalamic–pituitary–adrenal axis and immune mediated inflammation.
        NEJM. 1995; 332: 1354-1361
        • Sander D.
        • Klingelhöfer J.
        Stroke-associated pathological sympathetic activation related to size of infarction and extent of insular damage.
        Cerebrovasc. Dis. 1995; 5: 381-385
        • Smith K.E.
        • Hachinski V.C.
        • Gibson C.J.
        • Ciriello J.
        Changes in plasma catecholamine levels after insula damage in experimental stroke.
        Brain Res. 1986; 375: 182-185
        • Franceschini R.
        • Gandolfo C.
        • Cataldi A.
        • Del Sette M.
        • Cianciosi P.
        • Finocchi C.
        • et al.
        Twenty-four-hour β-endorphin secretory pattern in stroke patients.
        Stroke. 1994; 25: 2142-2145
        • Christensen H.
        • Boysen G.
        • Christensen E.
        • Johannesen H.H.
        • Bendtzen K.
        Plasma cytokines in acute stroke.
        J. Stroke Cerebrovasc. Dis. 2002; 11: 72-79
        • Christensen H.
        • Boysen G.
        • Christensen E.
        • Johannesen H.H.
        • Bendtzen K.
        Deteriorating ischaemic stroke: cytokines, soluble cytokine receptors, ferritin, systemic blood pressure, body temperature, blood glucose, diabetes, stroke severity, and CT infarction-volume as predictors of deteriorating ischaemic stroke.
        J. Neurol. Sci. 2002; 201: 1-7
        • Lindenstrøm E.
        • Boysen G.
        • Christiansen L.W.
        • à Rogvi Hansen B.
        • Nielsen P.W.
        Reliability of Scandinavian neurological stroke scale.
        Cerebrovasc. Dis. 1991; 1: 103-107
        • van Swieten J.C.
        • Koudstaal P.J.
        • Visser M.C.
        • Schouten H.J.A.
        • van Gijn J.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • van der Worp H.B.
        • Claus S.P.
        • Bär P.R.
        • Ramos L.M.P.
        • Algra A.
        • van Gijn J.
        • et al.
        Reproduceability of measurements of cerebral infarct volume on CT Scans.
        Stroke. 2001; 32: 424-428
        • Candelise L.
        • Landi G.
        • Orazio E.N.
        • Boccardi E.
        Prognostic significance of hyperglycemia.
        Arch. Neurol. 1985; 42: 661-663
        • Boysen G.
        • Christensen H.
        Stroke severity determines body temperature in acute stroke.
        Stroke. 2001; 32: 413-417
        • Desborough J.P.
        The stress response to trauma and surgery.
        Br. J. Anaesth. 2000; 85: 109-117
        • DeGraba T.
        • Hallenbech J.M.
        • Petigrew K.D.
        • Dutka A.J.
        • Kelly B.J.
        Progression in acute stroke.
        Stroke. 1999; 30: 1208-1212
        • Telle D.S.
        Salt and blood pressure revisited.
        BMJ. 1996; 312: 1240-1241
        • Sapolsky R.M.
        • Pulsinelli W.A.
        Glucocorticoids potentiate ischemic injury to neurons: therapeutic implications.
        Science. 1985; 229: 1397-1400