Serum BD-tau is elevated acutely in CSVD-related recent small subcortical infarct, correlates with infarct size and normalises by 3 months, but was not associated with chronic CSVD neuroimaging features or disease progression, suggesting sensitivity to acute neuronal injury rather than chronic or progressive CSVD.
Baseline serum BD-tau was higher in patients with a recent small subcortical infarct (RSSI) than in controls.
Baseline BD-tau correlated with infarct diameter.
BD-tau levels were not related to the time from symptom onset to blood sampling.
BD-tau was not associated with chronic CSVD neuroimaging features at any timepoint.
BD-tau levels returned to control levels by 3 months and remained stable at 15 months.
BD-tau was not associated with CSVD progression (new vascular MRI lesions on follow-up) or with functional neurological outcome.
The authors interpret BD-tau as reflecting acute neuronal injury rather than chronic or progressive small vessel disease.
This study looked at a blood marker called brain-derived tau (BD-tau), which specifically reflects tau protein released from brain tissue, in people who had a small deep brain stroke (lacunar stroke) related to small vessel disease. The researchers measured it in 101 patients shortly after stroke and again at 3 and 15 months, and compared them with 47 controls. BD-tau was higher in stroke patients than controls soon after the stroke, and it was modestly higher in those with larger infarcts. By 3 months it had fallen to control levels and stayed there. It did not track with the amount of chronic small vessel damage seen on MRI (such as white matter changes, lacunes or microbleeds), with new brain lesions appearing on later scans, or with how well patients functioned later. This research suggests BD-tau may be a marker of acute brain injury from a small stroke rather than a measure of ongoing or long-term small vessel disease or a predictor of recovery. The effect on infarct size was modest, and the findings come from a single cohort, so further work would be needed to confirm them.
Gattringer T, Haidegger M, Tafrali C, Martinez-Serrat M, Pinter D, Fandler-Höfler S, et al.. (2026). Serum brain-derived tau in lacunar stroke and cerebral small vessel disease.. European stroke journal. https://doi.org/10.1093/esj/aakag133