الفهرس 
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Abstract
Summary
Stroke is the 5th leading cause of death in the United States, with one person dying every 4 minutes. It is a worldwide health problem, making a great contribution to mortality and morbidity of patients around the world. According to the Center of Disease Control & Prevention (CDC) in 2016 , strokes are the second leading cause of death in Egypt. For black people, stroke is the 3rd leading cause of death. Approximately 800,000 people have a stroke each year; about one every 40 seconds In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation .Our study is concerned with collateral hemodynamics in both extracranial and intracranial stenosis and the difference in cerebral collaterals between them .
Our study represents one of the studies to detect a rapid, objective, clinically accurate, non invasive , inexpensive , safe , portable technique which is transcranial duplex . Transcranial colour coded duplex using phase array 2.4 Hz probe (Ezaote my lab five ) is used to compare between cerebral collaterals in 2 groups of patients , one group with extracranial carotid stenosis , and the second group with both intracranial and extracranial carotid
Summary
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stenosis. regarding flow direction of cerebral collaterals as ophthalmic artery and anterior cerebral artery.
A cross sectional study is made in which we included 30 patients with acute cerebrovascular stroke admitted in the stroke unit in Ain shams university hospital , of different age , sex and risk factors. All patients were subjected to full clinical history and examination , MRI brain stroke protocol with MRA and carotid duplex. Patient’s neurological status was assessed via National Institute of Health and Stroke scale (NIHSS).
Among those 30 patients , 15 patients complained of significant extracranial stenosis only detected by carotid duplex , and another 15 patients complained of both significant extracranial stenosis and intracranial stenosis detected by MRA. Our study compared between these 2 groups and the results were as follows :
Acute cerebral stroke was more common in patients with male gender , with mean age 60 years old , most common risk factors were Hypertension , Diabetes milliteus , Ischemic heart disease , respectively
three patients with extracranial stenosis only obtained reversed flow in their Anterior cerebral arteriers and reversed ophthalmic arteriers , furthermore we used Pulsitily index in those 30 patients to assess cerebral bed IV resistance with no significant difference between the 2 groups , with Mean (0.939± 0,238) in
Summary
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those 15 patients with extracranial stenosis , and Mean (0.910± 0.137) in those 15 patients with both intracranial stenosis . This was not statistically significant may be due to small sample size.
Those 15 patients with extracranial stenosis only showed less NIHSS (less deficit) with mean (8.333±2.795) than those 15 patients with both intracranial and extracranial stenosis who showed higher NIHSS (more deficit) with mean (12.733±2.631), which detects probably worse prognosis of second group of patients with both intracranial and extracranial stenosis.
Those 15 patients with extracranial stenosis showed less mRS both upon discharge with mean (2.067 ± 1.033 ) and after 3 months with mean (1.200 ± 0.941 ) than those 15 patients with both intracranial and extracranial stenosis both upon discharge with mean (2.800 ±0.862 ) and after 3 months with mean ( 2.933 ± 1.534). Consequently the first group with only extracranial stenosis showed more significant improvement than the second group.