الفهرس 
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Abstract
This prospective study was conducted to identify the relationship
between initial assessment in patients with acute ischemic cerebral stroke
and their outcome. The study was undertaken at Neuropsychiatric
Department in Suez Canal University Hospital. Fifty nine (59) patients
with acute ischemic stroke of > 18 years old were recruited consecutively
after taking an informed consent. Diagnosis of ischemic stroke was based
on clinical examination and it was confirmed by brain CT. All patients
were subjected to initial assessment including full history, clinical
examination, laboratory investigations, CT brain scan and outcome
measures.
The mean age of the patients was 61.8 ± 10.57 years. The male
patients were 30 (50.8%) and the female patients were 29 (49.2%).
Twenty three (39%) patients were smokers. There were 30 (50.8%)
diabetic patients, 56 (94.9%) hypertensive patients and 27 (45.8%) of the
stroke patients had IHD. Twenty five (42.4%) patients had GCS score 13-15, 22 (37.3%) patients had GCS score 9 -12 and 12 (20.3%) patients had
GCS score ≤ 8. The mean HR, SBP, DBP and temperature were 92.88 ±
21.5, 157.8 ± 30.1, 95.59 ± 22.6 and 37.8 ± 0.8, respectively. The mean
NIHSS of the studied stroke patients was 13.27 ± 7.4.
Thirty four (57.6%) of the studied stroke patients had anemia, 12
(20.3%) of them had thrombocytopenia and 9 (15.3%) of them had
leucocytosis. The mean values of RBS (180.22 ± 94.6), FBS (145.9 ±
92.2), triglycerides (121.6 ± 52.9), prothrombin time (17.5 ± 2.3) and
serum creatinine (1.7 ± 1.6) were abnormal in the studied stroke patients.
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Lacunar infarction was the most common infarction detected in 17
(28.8%) patients, followed by total anterior circulation infarction (15
patients, 25.4%) and posterior circulation infarction (15 patients, 25.4%)
and least frequent site was partial anterior circulation infarction ( 12
patients, 20.3%).
The majority of the patients had poor outcome (36 patients, 61%);
(27.1% of the patients died, 15.3% had vegetative state and 18.6% had
severe disability), while 23 patients (39%) had good outcome; (32.2% of
the patients had moderate disability and 6.8% had good recovery).
Fitting factors predicting outcome of ischemic stroke patients were,
arranged according to odds ratio, GCS (≤ 8) (OR=4.5), NIHSS (> 17)
(OR=3.9), posterior circulation infarction on CT (OR=3.6), age (> 70
years) (OR=1.5), creatinine (> 2) (OR=1.3) and smoking (OR=1.3).
Poor outcome patients had significantly higher mean age patients
(75.9 ± 6.9 years) than good outcome patients (62.5 ± 5.1 years) (p<0.01).
Smoking was highly significant more frequent in poor outcome patients
(55.6%) than good outcome patients (13.1%) (p<0.001). There was no
significant difference between poor and good outcome patients as regards
gender (p>0.05). There were no statistically significant differences
between both groups according to history of DM and IHD (p>0.05).
Poor outcome patients had highly significant mean HR and NIHSS
than good outcome patients (p<0.01). Poor outcome patients had
statistically highly significant lower mean SBP, DBP and GCS than good
outcome patients (p<0.01). There were no statistically significant
difference between both groups regarding body temperature (p>0.05).
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Poor outcome patients had significantly higher mean total
cholesterol (259.4 ± 67.5 mg/dl), triglycerides (239.5 ± 42.5 mg/dl), LDL
(115.6 ± 35.4 mg/dl) and serum creatinine (4.6 ± 2.7 mg/dl) than good
outcome patients (183.6 ± 98.4, 114.6 ± 46.8, 64.5 ± 23.5 and 1.5 – 1.4,
respectively) (p<0.01). Also, poor outcome patients had significantly
lower mean HDL than good outcome patients (p<0.01).
There were no statistically significant differences between both
groups regarding other laboratory findings (anemia, leucocytosis,
thrombocytopenia, RBS, FBS, PPBS and prothrombin time) (p>0.05).
Poor outcome patients had highly significant prevalence of
posterior circulation infarction (36.2%) than good outcome patients
(8.6%) (p=0.03). There were no statistically significant differences
between both groups regarding other CT findings (total anterior
circulation infarction, partial anterior circulation infarction and lacunar
infarction) (p>0.05).
Logistic regression analysis of the significant variables in the
studied ischemic stroke patients showed that HTN, FBS and PPBS were
the significant variables which correlated with poor outcome of the
patients.