الفهرس 
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Abstract
Fasting during Ramadan is essentially a radical change in lifestyle for the period of one lunar month that may affect stroke patients.
The objective of this study was to investigate the effect of Ramadan fasting in patients with ischemic cerebrovascular stroke.
Descriptive approach was selected for conducting this study during Ramadan and one month following Ramadan for 2 consecutive years 2012 -2013.
Two Groups of adult stroke patients were included:
Group I consisted of (392) cases presenting with acute ischemic cerebrovascular stroke attending Alexandria university hospitals (El-Hadra and Alexandria main university) and Gamal Abel Naser hospital during Ramadan (191) and one month following Ramadan (201) in two consecutive years 2012 and 2013.This Group was further subdivided in to Group IA (fasting) and Group IB (non fasting) .
Group II consisted of 250 cases; with previous history of ischemic cerebrovascular stroke attending outpatient clinics of Alexandria University hospital and Gamal Abd El Naser clinics were asked about their status during Ramadan.
Data were collected using the following tools:
I. Interview questionnaire
It was used to collect information from patients or their care givers concerning demographics, fasting, medical and present history.
II. Clinical Examination
Full neurological examination and assessment of stroke severity using NIHSS and Outcome using Glascow outcome scale and Barthel index.
III. Transfer sheet to collect information concerning
Vital signs, routine laboratory investigation and CT brain findings and carotid Doppler.
The Following Results were obtained:
There was statistically insignificant difference regarding stroke frequency over the 4- months.
1. Risk factors among Group IA (Fasting) and Group IB( non fasting)
Concerning sex, insignificant difference was found among both Groups.
Concerning age, Group IA (fasting) was significantly younger in comparison with the non fasting Group.
Smoking was significantly higher among Group IA (fasting).
There was no statistically significant difference concerning diabetes and hypertension in both Group IA and IB .
The duration of diabetes and hypertension was significantly shorter in Group IA (fasting) than in Group IB (non fasting)
The treatment of diabetes a higher percentage of cases were on insulin in Group IB in comparison to Group IA
Insignificant differences were found between Group IA (fasting) and Group IB (non fasting) concerning the presence and type and treatment of cardiac disease.
Insignificant difference was found between two Groups concerning previous history and number of attacks of ischemic cerebrovascular stroke or treatment with antiplatelet.
2. Seeking medical advice concerning fasting
A significantly higher percentage of Group IA (fasting) sought advice about whether or not to fast than Group IB (non fasting).
A significantly higher percentage among Group IB (non fasting) were advised against fasting than in Group IA (fasting). Insignificant difference was found between Group IA (fasting) and Group IB (non fasting) concerning reporting going out during day time.
3. New onset stroke cases (Group I) and the presenting symptoms in Ramadan, timing of stroke onset and location on CT.
• Presenting symptoms.
The highest percentage of the presenting symptom was motor weakness; Followed by Speech and articulation defect next was cranial nerve affection in both studied Groups.
There was insignificant difference regarding the motor weakness, yet the speech, articulation as well as the cranial nerve affection were significantly higher among Group IB than in Group IA
• Timing of stroke onset
In Group IA (fasting) 63.8% of cases presented with stroke in the time interval 12 pm and 6pm while in Group IB ( non fasting) 42.1% presented with stroke in the time interval 12 pm and 6pm constituting a significant shift in circadian rhythm of stroke onset .
• New onset stroke cases (Group I) and stroke location
Highest percentage in the fasting Group was anterior circulation strokes (46%) followed by lacunar infarcts 28% and posterior circulation strokes 12.8%.
As for the non fasting Group the highest percentage was in the anterior circulation 43.3 % followed by lacunar infarcts 42.6 %the next was TIA 8.3%. This difference was statistically significant.
4. Vital signs
Insignificant differences were found between two Groups concerning vital signs.
5. Laboratory results
Insignificant differences were found between fasting and non fasting stroke cases concerning laboratory results except for serum sodium was significantly higher among the non fasting Group.
6. New onset stroke cases(Group I) and carotid Doppler findings
Insignificant difference was found between Group IA (fasting) and Group IB (non fasting) concerning carotid Doppler findings.
7. Distribution of Group IA (fasting) and Group IB (non fasting) regarding stroke severity and outcome.
There was no statistically significant difference regarding stroke severity or outcome between both studied Groups using NIHSS, Barthel and Glascow outcome scales.
8. Risk factors of Group I (Ramadan and post Ramadan cases) and Group II (Cases with history of ischemic stroke)
Insignificant difference was found between Group I and II concerning smoking.
Diabetes and its duration was significantly higher among Group I in comparison to Group II.
Hypertension was insignificantly higher In Group II .while The duration of hypertension was significantly longer in Group I (9.20 ± 6.22 years) than among Group II (4.44 ± 2.99 years).
In Group I, 28.8% were cardiac while in Group II, 47.2% were cardiac this difference was statistically significant.
In Group I, 69.9% had ischemic heart disease and 26.5% had atrial fibrillation, while in Group II 55.1% had ischemic heart disease and 44.9% had atrial fibrillation this difference was statistically significant.
Insignificant difference was found concerning the number of previous ischemic stroke attacks yet a significantly higher percentage of cases were on antiplatelet therapy among Group II in comparison to Group I