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• Stroke is a leading cause of disability and morbidity and the fourth leading cause of death in the United States, and the second leading cause of death worldwide.

• Early restoration of blood flow is the most effective treatment of ischemic stroke by intravenous thrombolytic therapy within 3-4.5hrs of symptom onset.

• Patient outcomes have been shown to improve with earlier thrombolytics, each 15 minute increment increases survival by 3.0-4.0%.

• Non-contrast CT is the current standard for differentiation of stroke. It is beneficial due to speed of acquisition and its high sensitivity in ruling out hemorrhagic stroke.

• However, with almost half of the US population living more than an hour from a Primary Stroke Center, the need to differentiate early in rural hospitals is increasingly important.

• The purpose of this study is to determine if biological markers like GFAP compared to CT can accurately differentiate ischemic stroke, hemorrhagic stroke, and stroke mimic.

• This literature review explores the studies that compare current biological markers in ischemic, hemorrhagic stroke, and stroke mimic, and then compares their accuracy to that of neuro imaging.

• This panel of biological markers could minimize the duration to thrombolytic therapy in patients suffering from ischemic stroke by allowing early differentiation in the rural hospital setting.

• The findings indicate that the sensitivity and specificity of a panel of biological markers, clinical judgment, and clinical tools such as NIHSS stroke scale, can approach that of the non-contrast head CT in rural setting, improving time to care and stroke recovery.


Physician Assistant Studies

Degree Name

Master of Physician Assistant Studies (MPAS)

First Advisor

Jay Metzger

Publication Date



Biomarkers; Neuroimaging; Stroke -- etiology; Comparative Study


Cardiovascular Diseases

Serum Biomarkers Compared to Neural Imaging in the Differentiation of Stroke Etiologies