الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Stroke is the third leading cause of death and the most frequent cause of permanent disability worldwide (Donnan et al., 2008), and inflammation appears to play an important role in the pathogenesis of ischemic stroke and other forms of ischemic brain injury. Clinically, the susceptibility of the patients to stroke and the subsequent prognosis are influenced by systemic inflammatory processes (Emsley et al., 2008; McColl et al., 2009). Stroke patients with systemic inflammation exhibit clinically poorer outcomes (Rong Jin et al., 2010).
Evidence from experimental studies suggests a direct role of leukocytes in the pathogenesis of ischemic injury. This evidence goes beyond histological accumulation to a more direct role in ischemic pathophysiology.
Thus, our study which was a case control study aimed to assess the role of neutrophils in the pathogenesis of acute ischemic stroke in humans (collected within 24 hours of brain insult) by measuring neutrophil count and level of the biomarker of neutrophil activity neutrophil gelatinase associated lipocalin (N-GAL) and comparing it to healthy controls, and we assessed the link between early total and differential peripheral leukocyte counts and volume of ischemic tissue.
The study was conducted on 40 patients aged ≥ 40yrs old recruited from the emergency department at Ain Shams University hospital, and 20 apparently healthy subjects as healthy controls. They were subdivided into 3 groups
group A: 20 healthy people as controls
group B: 20 diabetic patients (± HTN) with no previous history of stroke group C: 20 diabetic patients (± HTN) with acute ischemic stroke
All 3 groups were subjected to thorough history, full neurological examination, blood pressure measurement following a 10-minute rest in a sitting position, Diffusion-weighted MR imaging (DWI) of brain done within the first few hours after stroke with measuring of DWI lesion volumes, Fasting/2 hours post prandial blood sugar, HgB A1C, total cholesterol (HDL, LDL) and triglycerides, CBC with differential count, CRP, ESR and Neutrophil gelatinase-associated lipocalin (NGAL) essay as a marker of neutrophil activation.
We observed from this study:
The mean age of patients suffering of acute cerebrovascular stroke was 62.6 years with no sex predilection.
In all our patients who were diabetics, the duration of hypertension was a risk factor of acute cerebrovascular stroke with a mean duration of affection of 9 years. Another risk factor was poor glycemic control in the form of higher HBA1C levels in stroke patients.
Total leucocytic count and neutrophil count were not one of the detected risk factors of cerebrovascular stroke in our study.
Neutrophil gelatinase-associated lipocalin (NGAL) was a risk factor of stroke and was negatively correlated to the size of stroke. Moreover, N-GAL level was found to have a very good predictive value of cerebrovascular stroke in the whole study population, the best cut off value of N-GAL was 0.7 μg/l.N-GAL had a sensitivity of 60% and a specificity of 87.5%. Among the predictors of the size of the stroke were hypertension and NGAL levels which were negative predictors of the size of stroke, whereas, neutrophil count was a positive predictor.
In conclusion, NGAL level; a biomarker of neutrophil activity, was a risk factor of acute cerebrovascular stroke that can be used as a predictor of stroke among patients. Moreover, NGAL level a negative predictor of th size of stroke. Our study points to the possibility of treating stroke in the future as an inflammatory disease using drugs targeting certain inflammatory cells,cytokines and other markers of immune response to ischemia after performing wide scale studies.