الفهرس Only 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
This study was done to assess the association between the serum ferritin level at the first 24 hours following acute stroke and the clinical severity and prognosis of the stroke.
Thirty four patients with acute stroke, 21 had ischaemic stroke and 13 had hemorrhagic stroke were selected from intensive care unit and stroke unit, Neurology Department, Zagazig University Hospital during period from November, 2005 to October 2006. They were divided into two groups according to the clinical course on admission and at 21 days after stroke onset as assessed by the CANS.
1- Group I (Improved patients): included 17 patients. Their CANS was 7.5 or more, and higher than the one on admission.
2- Group II (deteriorated patients): included 17 patients. Their final CANS did not exceed a score of 7, and less than the one on admission.
All patients were subjected to the following:
1- Detailed history taking.
2- Complete general and neurological examination.
3- Assessment of stroke severity using CANS during the first 24 hours of stroke onset and at 21 day after stroke onset.
4- Laboratory investigations including, CBC, RBG, liver and kidney function tests, lipid profile, uric acid, CRP and serum cortisol level.
5- Serum ferritin level within 24 hours of stroke onset using immunoassay.
6- ECG and echocardiography.
7- Computed tomography of the brain (C.T).
The results showed that:
- There was a highly significant difference between improved and deteriorated stroke patients regarding age, and there was no significant difference between the two groups regarding sex and stroke type.
- The admission mean, systolic and diastolic blood pressure, RBG level, uric acid and C.T. lesions size were significantly higher in deteriorated stroke patients.
- A significant correlation was found between serum ferritin and age of patients.
- There was no significant difference in mean level of serum ferritin between male and female patients.
- There was no significant difference in the mean level of serum ferritin between ischaemic and hemorrhagic stroke patients.
- The mean level of serum ferritin was highly significant, higher in deteriorated stroke patients in comparison with improved stroke patients.
- There was a highly significant inverse correlation between serum ferritin level within first 24 hours of stroke onset and stroke severity as assessed by CANS on the first day and at 21 day following stroke onset.
- The mean level of serum cortisol was significantly higher in deteriorated stroke patients than in improved stroke patients.
- There was no significant correlation between serum ferritin level within first 24 hours of stroke onset and serum cortisol level and CRP.
- The mean serum ferritin level was highly significant higher in patients with large CT lesions in comparison with those of medium and small CT lesions.
- Significantly high levels of mean serum ferritin level was detected in stroke patients with high random blood glucose, hypertensive stroke patients, cardiac patients and stroke patients with high serum cholesterol and triglycerides levels while there was no significant increase of mean serum ferritin level detected in smoking stroke patients.
Conclusion:
In conclusion the high serum ferritin level as reliable index of elevated iron stores could accelerate the production of oxygen free radicals in the early period following hypoxic ischaemic episode and the intracerebral hemorrhage which result in greater oxidative stress, massive brain tissue damage and poor outcome after stroke. Ferritin also is linked to several stroke risk factors such as hypertension, diabetes mellitus, atherosclerosis and cardiac disease.
Recommendations:
- In view of our results, we recommend future larger studies about the role of ferritin in ischaemic and hemorrhagic cerebrovascular stroke.
- Serum ferritin measurement should be included in future investigations as a prognostic factor in acute stroke.
- Future studies about application of antioxidant drugs and iron chelating agents to reduce the effect of ferritin especially in patients with increased body iron stores and as a prophylactic and active treatment of acute stroke.