Acute-phase vitamin B12 and folic acid levels in patients with ischemic and hemorrhagic stroke: is there a relationship with prognosis?

Objective: The aim of this study was to investigate blood folic acid and vitamin B12 levels in patients with ischemic and hemorrhagic stroke patients and correlate these levels with prognosis. Methods: Patients presenting within 3 hours of onset of ischemic or hemorrhagic strokes were approached for participation in the study. Diagnosis was made by clinical examination and head computed tomography scan. Venous blood samples were taken for determination of blood folic acid and vitamin B12 levels. Parameters were evaluated with respect to stroke type and according to Glasgow coma scale (<= 8 or >= 9). Results: Eighty-seven patients with ischemic stroke (mean age: 65 +/- 10 years, 53% male) and 27 patients with hemorrhagic stroke (mean age: 60 +/- 10 years, 56% male) were included in the study. A significant direct correlation was found between Glasgow coma scale and mean plasma B12 levels in ischemic, but not hemorrhagic, stroke (r=112.75 and p=0.007, respectively). A significant direct correlation was found between Glasgow coma scale and mean plasma folic acid levels in hemorrhagic, but not ischemic, stroke (r=1.03 and p=0.017, respectively). In patients with Glasgow coma scale <= 8 (either hemorrhagic or ischemic stroke), a significant direct correlation was found between Glasgow coma scale and blood vitamin B12 levels. Vitamin B12 levels were significantly lower in patients with Glasgow coma scale (8 than in patients with Glasgow coma score >= 9 (p=0.04). Conclusions: In patients with ischemic stroke, low vitamin B12 levels, and in patients with hemorrhagic stroke, low blood folic acid levels, are associated with lower Glasgow coma scale values and higher hospital mortality.