L-Glutamate Profile in Acute Ischemic Stroke After Intra Arterial Heparin Flushing

Tugas Ratmono , Ilhamjaya Patellongi, Cahyono Kaelan, Andi Wijaya, Andi Asadul

Tugas Ratmono
Hasanuddin University Makassar. Email: tugas_ratmono139@yahoo.com

Ilhamjaya Patellongi

Cahyono Kaelan

Andi Wijaya

Andi Asadul

Online First: June 01, 2016 | Cite this Article
Ratmono, T., Patellongi, I., Kaelan, C., Wijaya, A., Asadul, A. 2016. L-Glutamate Profile in Acute Ischemic Stroke After Intra Arterial Heparin Flushing. Bali Medical Journal 5(1): 169-174. DOI:10.15562/bmj.v5i1.211

Objective:The intra arterial heparin flushing ( IAHF ) is one of  the endovascular procedure that in facts have benefit effect to improving the motoric function after acute ischemic stroke, but the exact mechanism not yet known clearly. The L-glutamate is a neurotransmitter that have important role in the brain metabolism. How the profile of L-glutamate after IAHF not yet published. The purpose of this study is to know how the IAHF affect the Glutamate concentration in the blood and muscle function which measured by Manual Muscle Testing-Medical Research Councils (MMT-MRC) in Acute Ischemic Stroke Patients.

Method: The thirty nine patients of acute ischemic stroke that admitted to hospital, was studied of L-Glutamate serum profile. The patients grouping depend on onset ( <7 days, 7-14 days after stroke onset ), site of infarction ( cortical and subcortical ), and size of infarction ( lacunar and wide infarct ). The outcome of motoric function was recorded and measured by MRCs ( Motoric Research Council Scale ; 0-5 ) in the arm weakness, MRCs < 18 ; severe, 18-23; moderate, 24-29; mild ). The L-glutamate serum level measured before and after IAHF.

Results:Characteristic of sample = Onset : <7 days =  Before : 19,51±6,74. After : 20,64±7,45. P = 0,474. 7-14 days =Before : 18,70±6,08, After :22,70±7,72, p=0,046.Site of infarction; cortical = Before : 21,63±9,55, After : 25,94±8,22.P = 0,098; Subcortical = Before : 18,32±4,3,after : 19,69±6,58. p = 0,370. Size of infarct : Lacunar = before : 18,32±4,3.After : 19,69±6,48. p= 0,370. Non-Lacunar = Before : 21,63±9,55. After : 25,94±8,22, p = 0,098. Muscle Strength : MRCs < 18 = before : 16,68±5,13, after : 19,67±5,72, p= 0,060. MRCs (Upper Arms) 18-23; Before : 24,70±4,72, After : 27,95±6,93, p = 0,372. MRCs 24-29;  Before : 18,17±6,93 After : 20,53±7,89, p = 0,248.

Conclusion:The L-glutamate serum level was increasing after IAHF, but not significantly different according to the all of group in this study.

Keywords:L-glutamate, acute ischemic stroke, IAHF, muscle strength


Purves D, Augustine GJ, Fitzpatrick D, et al. 2001. Neuroscience 2nd Edition.

Putranto, T., Yusuf, I., Murtala, B., Wijaya, A. 2016. Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient. Bali Medical Journal 5(2): 25-29.

Neuronal Death by Glutamate Excitotoxicity : Protein Mediators & Strategies for Inhibition. 2012. (https://www.rndsystems.com/resources/articles/neuronal-death-glutamate-excitotoxicity-protein-mediators-strategies-inhibition)

Davalos A., Castillo J., Serena J., Noya M. 1997. Duration of glutamate release after acute ischemic stroke. Stroke : 28:708-10.

Castillo J., Davalos A., Naveiro J., Noya M. 1996. Neuro-excitatory amino acids and their relation to infarct size and neurological deficit in ischemic stroke. Stroke 27:1060-5.

Prass K., Dirnaql U. 1998. Glutamate antagonists in therapy of stroke. Restor Neurol Neurosci 13(1-2):3-10.

Dietrich W.D., Globus M.Y.T. The Role of Neurotransmitters in Brain Injury. p41-42

Leibowitz A., Boyko M., Shapira Y., Zlotnik A. 2012. Blood Glutamate Scavanging : Insight Into Neuroprotection. Int. J. Mol. Sci. 13.

Leighton M., Robert P., John U., Michelle S., David D., James S., et al. 2001. Pictorial Review of Glutamate Excitotoxicity : Fundamental Concepts for Neuroimaging. 22:1813-1824.

Lewis D.S., Filer L.J., Baker G.L., Mueller S.M. 1979. Factors Affecting Plasma Glutamate Levels in Normal Adult Subjects. Departments of Pediatrics, Biochemistry, & Neurology Iowa.

Leach M.J., Swan J.H., Eisenthal D., Dopson M., LIBiol, Nobbs M. 2016. BW619C89, a Glutamate Release Inhibitor, Protects Against Focal Cerebral Ischemic Damage. Stroke (24):7.

Ted W.L.., Zhang S., Wang Y.T. 2013. Excitotoxicity and Stroke : identifying novel targets for neuroprotection. Progress in Neurobiology 115(2014):157-188.

Malarkey E.B., Parpura V. 2008. Mechanism of Glutamate release from Astrocytes. Neurochem Int. 52(1-2): 142-154.

Zlotnik A., Sinelnikov I., Gruenbeum B., Gruenbeum S., Dubilet M., Dubilet E., et al. 2012. Effect of Glutamate and Blood Glutamate Scavengers Oxaloacetate and Pyruvate on Neurological Outcome and Pathohistology of the Hippocampus after Traumatic Brain Injury in Rats. Anesthesiology (116):73-83.

Gottlieb M., Wang Y., Teichberg V.I. 2003. Blood-mediated Scavenging of Cerebrospinal Fluid Glutamate. J Neurochem (87):119-26.

Meldrum B.S. 2000. Glutamate as a Neurotransmitter in the Brain : Review of Physiology and Pathology. Department of Clinical Neurosciences London.

Dugan L.L., Bruno V.M., Amagasu S.M., Giffard R.G. 1995. Glia Modulate the Response of Murine Cortical Neurons to Excitotoxicity : Glia Exacerbate AMPA Neurotoxicity. J Neurosci. (15):4545-4555.

Rosenberg P.A., Aizenman E. 1989. Hundred-fold Increase in Neuronal Vulnerability to Glutamate Toxicity in Astrocyte-poor Cultures of Rat Cerebral Cortex. Neurosci. Lett (103):162-168.

Volobueva L.A., Suh S.W., Swanson R.A., Giffard R.G. 2007. Inhibition of Mitochondrial Function in Astrocytes : Implications for Neuroprotection. J Neurochem (102):1383-1394.

Wardlaw J.M., Sandercock P.A., Berge E., 2003. Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke : Where do we go from here? A Cumulative Metaanalysis. (34):1437-1442.

Swanson R.A., Ying W., Kauppinen T.M. 2004. Astrocyte Influences on Ischemic Neuronal Death. Mol Med (4):193-205.

Giffard R.G., Swanson R.A. 2005. Ischemia induced Programmed Cell Death in Astrocytes, Glia. (50):299-306.

Adams H.P. Jr., Bendixen B.H., Kapelle L.J., et al. 1993. Classification of subtype of acute ischemic stroke. Stroke (24):35-41

Ames A. 2000. CNS energy metabolism as related to function. Brain Res Rev (34):42-68.

Cherubini A., Ruggiero C., Polidori M.C. 2005. Potential Marker of Oxidative Stress in Stroke, Free Radic Biol Med (39):841-52.

Coull, B.M., Williams, L.S, Goldstein, L.B., et al. 2002. Anticoagulants and Antiplatelet Agents in Acute Ischemic Stroke : Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association). Stroke. 33: 1934-1942

Dvorak, M., Vlasin, M., Dvorakova, M., et al. 2010. Heparin and its Derivatives in the Treatment of Arterial Trombosis: A Review. Vet Med. 55: 523–546

Coutinho, J., de Bruijn, S. F. T. M., deVeber, G., Stam, J. 2011. Anticoagulation for Cerebral Venous Sinus Trombosis. Cochrane DB Syst Rev. 8: 1- 21.

Paternostro-Sluga T., Stieger-Grim M., Posch M. 2008. Reliability and Validity of the Medical Research Council (MRC) Scale and A Modified Scale for Testing Muscle Strength in Patients with Radial Palsy. J Rehabil Med (40):665-671.

Durran A.C., Watts C. 2012. Current Trends in Heparin Use During Arterial Vascular Interventional Radiology. Cardiovasc InterventRadiol 35: 1308-1314.

Perrey S. 2013. Promoting Motor Function by Exercising the Brain. Brain Sciences 3:101-122.

Sacco R.L., Kasner S.E., Broderick J.P. et al. 2013. An Updated Definition of Stroke for the 21st Century : A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 44:2064-2089.

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