الفهرس 
Assessment of Predictors of Recurrent Ischemic Stroke in a Sample of Egyptian Stroke Patients
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Abstract
Background : Stroke is the third leading cause of mortality, and a major cause of disability worldwide. Patients who experienced a first ischemic stroke are at high risk of recurrence with estimated risk of 8-14% within the first year. Exploring the clinical, laboratory and imaging predictors of stroke recurrence will contribute to the prevention of stroke recurrence. Objective: To assess predictors of recurrent ischemic stroke and to estimate the relative prevalence and cumulative risk time for recurrent ischemic stroke in a sample of Egyptian strokepatients admitted to Stroke Unit, Kasr Elainy Hospital-Cairo University,from Sep.2021 to Apr.2022.Design and Methods: This is a case-control study conducted on 96 participants divided into: 32 first time ischemic stroke cases, 32 recurrent ischemic stroke cases and 32 healthy controls,matched to cases. First and recurrent stroke subjects were subjected to detailed neurovascular history and examination, laboratory tests, extracranial and transcranial duplex, echo, ECGand brain MRI.Cases compared to controls by Neutrophil/Lymphocyte Ratio (NLR). Results:In this study the relative prevalence of recurrent ischemic stroke was 21%. Factors significantly associated with recurrent ischemic stroke(p≤0.05)include hypertension, transient ischemic attack (TIA), increased carotid intimal medial thickness (IMT), and multiple infarctions. Sensitivity analysis showed that age (cutoff 60 years) was the only predictor of recurrent stroke. Logistic regression showed that smokinganddiabetes mellitus (DM)were independent predictors of recurrent stroke. Hazard test showed that recurrence after 1 year was significantly associated with large size of left atrium (LA).NLR was significantly higher in both first and recurrent stroke compared to controls. The most common TOAST subtype was large artery atherosclerosis (LAA) in first time stroke and cardioembolic (CE) in recurrent stroke.Time for first recurrence after 6 months was 54.6 months while after 1 year it was 84.1 months. Conclusion:Significant predictors of recurrent ischemic stroke include old age, diabetes mellitus, smoking and dilated left atrium. Neutrophil to LymphocytesRatio (NLR) was significantly higher in both first and recurrent ischemic stroke compared to controls. Cardioembolic stroke was the most common TOAST subtype in recurrent ischemic stroke.