الفهرس 
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Abstract
Worsening of acute stroke early in its course (within 48–72 h of its onset) is a common occurrence and has potentially serious short term and long term consequences for the patient (Thanvi et al., 2008).
Many studies consider increase in the total national institute of health stroke scale (NIHSS) score by at least 2 points a significant neurological deterioration (Helleberg et al., 2014: Kwan et al., 2006: Siegler et al., 2016: Haung et al., 2018).
The incidence of END in ischaemic stroke among hospitalized patients varies widely in different studies between 13% and 38%.
The current study is a hospital based prospective observational study carried out during the period from January 2017 to June 2018 at ain shams university hospitals.
This study aimed to define the incidence, severity and timing of END in relation to AIS onset, possible causes and predictors associated with END after AIS and to assess the relation between END after AIS and the patient functional level at three months post stroke including case fatality.
Three hundred Egyptian patients were recruited into this study. Clinical history, laboratory indices, structural brain imaging, Magnetic Resonance Angiography (MRA) and Carotid Duplex ultra sonography were done for all patients.
All patients were examined on NIHSS and Glasgow Coma Scale (GCS) in the 1-2-3 day and all patients with END did a follow up (MRI diffusion film or CT brain) at day4 or 5 and all patients were followed up by Modified Rankin scale (MRs) at three-month post stroke.
Of the Three hundred patients included in the study, the incidence of END was 16.7%. The median NIHSS on admission was 9.25 (11 in END group and 9 in non END group). END was associated with long duration of DM (P 0.012), IHD (p 0.015), AF (p 0.048), severe stroke (p 0.0044), low blood pressure on admission (p 0.0079), high uric acid (p 0.033) and MCA occlusion (p 0.0007). END was associated with significant increase in MRS at 3 month (4 vs 2, p<0.0001) and mortality rate (44% vs 4.4).
Patients with END are more prone for aspiration pneumonia (p 0.0001) and hemorrhagic transformation.
Our study concluded that: Early neurological deterioration is a frequent and important complication in acute stroke, with a poor short-term prognosis.
This study provides further evidence that hyperglycemia, hyperuricemia and cardiac disease (IHD and AF) may increase the risk of END and Careful attention should be paid for patients with severe stroke and those with intracranial arterial disease to prevent or minimize the risk of complication like aspiration pneumonia and hemorrhagic transformation.