Abstract 2856: Lesion load of Corticospinal Tract and Initial Motor Impairment in the Acute Stroke Phase Predict Motor Impairment 3 Months Post-Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wuwei Feng ◽  
Jing Wang ◽  
Evgeny Sidorov ◽  
Christine Holmstedt ◽  
Christopher Doughty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Corticospinal Tract ◽  
Motor Impairment ◽  
Lesion Size ◽  
Sectional Area ◽  
Lesion Load ◽  
Cross Sectional ◽  
Post Stroke ◽  
Days Of Therapy

Background: We use lesion-mapping techniques in combination with diffusion tensor imaging to quantitatively test the hypothesis that motor impairment 3 months post- stroke is inversely related to the lesion load of the corticospinal tract (CST) in the acute stroke phase. Methods: We prospectively followed up a cohort of 32 patients who presented with their first-ever acute ischemic stroke with various degree of motor deficit , had a MRI during the hospitalization, and had follow-up motor assessments using the Fugl-Meyer Upper Extremity Scale (FM-UE) at 3 months (+/- 2 weeks) after stroke. We calculated a CST-lesion load for each patient by overlaying the patient’s lesion map from diffusion weighted image with a probabilistic DTI tract constructed from 12 age-matched healthy subjects . Both raw and weighted (which accounts for the narrowing of the CST as it descends from the motor cortex to the posterior limb of the internal capsule) were calculated; weighted lesion-loads were calculated by multiplying the lesion-tract overlap on each slice by the ratio of the maximum cross-sectional area of the tract to the cross-sectional area of the tract on that particular slice). A multiple regression is fit to assess the predicted value of CST lesion load (raw or weighted), along with other variables such age, gender, lesion size, initial impairment, days of therapy known to have an possible effect on motor outcome. Results: CST-lesion load and initial motor impairment are found to be significant predictors of upper extremity motor impairment at 3 months post-stroke. Age, gender, lesion size or days of therapy does not have predictive value in our cohort study. The adjusted R² is 0.63 with initial impairment and raw lesion load in the regression model, and is 0.66 with initial impairment and weighted lesion load. Conclusions: Our data shows the degree of motor impairment at 3 months after a first-ever ischemic stroke can be predicted by the overlap of the lesion with the canonical CST derived from age-matched healthy control subjects and the initial motor impairment measured in the acute phase.

Abstract 72: A Novel VLSM-CST Lesion Load Model is a Superior Predictor of Motor Outcomes of Acute Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jasmine Wang ◽  
Wayne Feng ◽  
Pratik Y Chhatbar ◽  
Gottfried Schlaug
Keyword(s):  
Acute Stroke ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
Lesion Load ◽  
Days Of Therapy ◽  
Motor Outcome ◽  
Motor Tracts ◽  
Best Fit

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR<0.05. Resulting VLSM T-maps were multiplied using our probabilistic CST maps, and then summed to form a canonical VLSM-weighted CST tract. Individual lesion maps from 76 acute stroke patients were overlaid onto the VLSM-weighted CST map to calculate lesion load. Patients were assessed for motor impairment (UE-FM) at baseline and at 3 months. Linear regressions were fit for baseline UE-FM, wCST-LL, and Days-of-Therapy (DoT) to determine predictions of 3-months outcome. A multivariate regression was run using VSLM-weighted CST-LL, controlling for baseline UE-FM and DoT. Age was not a significant regressor. Akaike Information Criterion was run to select the best fit model. Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

Corticospinal Tract Lesion Load Originating From Both Ventral Premotor and Primary Motor Cortices Are Associated With Post-stroke Motor Severity

2021 ◽  
pp. 154596832110684
Author(s):  
Kaori L. Ito ◽  
Bokkyu Kim ◽  
Jingchun Liu ◽  
Surjo R. Soekadar ◽  
Carolee Winstein ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Primary Motor Cortex ◽  
Corticospinal Tract ◽  
Motor Impairment ◽  
Higher Order ◽  
Lesion Load ◽  
Post Stroke ◽  
Stroke Lesion ◽  
Motor Outcomes ◽  
Probabilistic Map

Lesion load of the corticospinal tract (CST-LL), a measure of overlap between a stroke lesion and the CST, is one of the strongest predictors of motor outcomes following stroke. CST-LL is typically calculated by using a probabilistic map of the CST originating from the primary motor cortex (M1). However, higher order motor areas also have projections that contribute to the CST and motor control. In this retrospective study, we examined whether evaluating CST-LL from additional motor origins is more strongly associated with post-stroke motor severity than using CST-LL originating from M1 only. We found that lesion load to both the ventral premotor (PMv) cortex and M1 were more strongly related to stroke motor severity indexed by Fugl-Meyer Assessment cut-off scores than CST-LL of M1 alone, suggesting that higher order motor regions add clinical relevance to motor impairment.

Comparison of subchondral lesion size between clinical and non-clinical medial trochlear ridge talar osteochondritis dissecans in dogs

2007 ◽  
Vol 20 (01) ◽  
pp. 08-11 ◽  
Author(s):  
B. Van Ryssen ◽  
F. Coopman ◽  
H. van Bree ◽  
I. Gielen
Keyword(s):  
Osteochondritis Dissecans ◽  
Hind Limb ◽  
Lesion Size ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Bone Lesions ◽  
Sectional Area ◽  
Cross Sectional ◽  
Length Width ◽  
Measured Length

SummaryIn this retrospective study of nine dogs exhibiting bilateral medial trochlear ridge talar osteochondritis dissecans (MTRT-OCD) and unilateral hind limb lameness, we compared subchondral lesion size in limbs with visible lameness, with contralateral lesions that were not associated with any visible lameness. All MTRT-OCD lesions were imaged by radiography and computed tomography (CT). The dimensions of subchondral bone lesions were measured (length, width and depth) using CT software. Similar to a method used in humans, the estimated volume (length x width x depth) and cross sectional area (length x width) were calculated and compared. We found that MTRT-OCD lesions causing visible lameness were significantly larger, and were associated with more joint thickening and degenerative joint disease than contralateral lesions that were not associated with any apparent lameness. As in the disease of shoulder osteochondritis dissecans, there is probably a correlation between the size of MTRT-OCD lesions and the symptoms of lameness.

Abstract 13: Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David J Lin ◽  
Alison M Cloutier ◽  
Kimberly S Erler ◽  
Jessica M Cassidy ◽  
Samuel B Snider ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Corticospinal Tract ◽  
Standard Of Care ◽  
Major Effect ◽  
Motor Recovery ◽  
Post Stroke ◽  
Stroke Imaging ◽  
Recovery Potential ◽  
Structural Injury

Introduction: Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods: Patients (N = 48) with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer (FM) during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using four different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict delta FM. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results: 48 patients were enrolled 4.2 ± 2.7 days post-stroke and completed this study. CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with AUC values ranging from 0.75 to 0.8. In addition, CST injury explained ~20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing four different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions: Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in post-stroke upper extremity motor recovery.

Abstract WP323: Genetic Knockout of CD38 in Mice Protects Against Ischemic Stroke With Smaller Infarct Volumes and Decreased Motor Impairment

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yousef Hannawi ◽  
Surya Gnyawali ◽  
Mohamed G Ewees ◽  
Maria H Balch ◽  
Hallie Harris ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Stroke Volume ◽  
Open Field ◽  
Field Test ◽  
Open Field Test ◽  
Gene Knockout ◽  
Motor Impairment ◽  
Post Stroke ◽  
Infarction Volume

Introduction: Endothelial dysfunction is an important mediator of post ischemic injury of the heart and brain following ischemia/reperfusion (I/R). We have reported that CD38 activation in heart I/R models leads to NADPH depletion with endothelial nitric oxide synthase (eNOS) impairment, loss of endothelial-mediated coronary dilatation and increased myocardial infarction. While CD38 knockout or inhibition prevents this dysfunction and decreases myocardial infarction, the role of CD38 in ischemic stroke remains uncertain. Hypothesis: We hypothesize that loss of CD38 expression and activity through gene knockout is protective with smaller infarct volume. Methods: 15 week-old male CD38 knock out (KO) n=12 and wild type (WT) mice n=12 underwent middle cerebral artery occlusion (MCAO) for 60 minutes. Stroke volume was calculated using T2 MRI sequences on a 9.4 T MRI system acquired 48 hours post stroke with images analyzed using Osirix software. The ratios of the stroke volume to the affected hemisphere volume and the compensated swelling infarction volume percentage of normal hemisphere were calculated using established methods. Open field test to measure motor impairment was performed at baseline and 48 hours post stroke (KO, n=12, WT n=6). Statistical analysis was completed in STATA using Man-Whitney U test and T-test to compare infarct volumes and cognitive parameters. Values are shown as mean ± SD. P value < 0.05 was considered significant. Results: At 48 hours, brain MRI showed a smaller percentage of cerebral hemisphere affected by stroke in CD38 KO compared to WT (25.9±3.7 vs 41.1±9.4, respectively P=0.0001) and a smaller percentage of compensated swelling infarction volume of normal hemisphere in KO mice compared to WT (19.6±3 vs 33.5±9, respectively P=0.0001). Open field test showed significant post stroke motor impairment in WT compared to CD38KO mice (distance travelled 1.8±1 m vs 4.7±3 m, P=0.04, respectively and average speed 0.006±0.003 m/s vs 0.016±0.01m/s, P=0.04, respectively). Conclusions: Infarct volumes are smaller and motor impairment is decreased in CD38 KO mice compared to WT demonstrating that gene knockout of CD38 confers neuroprotection against acute ischemic brain injury.

Abstract TP439: Occurrence (Incidence and Prevalence) Rate of Delirium and Risk Factors in Acute Stroke - Cross-sectional Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Terence J Quinn ◽  
Robert Shaw ◽  
Martin Taylor-Rowan
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Acute Stroke ◽  
Cognitive Assessment ◽  
University Hospital ◽  
Initial Assessment ◽  
Cognitive Assessments ◽  
Cross Sectional ◽  
Post Stroke ◽  
Cognitive Problems

Introduction: Guidelines recommend screening all stroke admissions for cognitive impairment. Delirium may be an important contributor to cognitive problems, but available data are limited by potential selection biases and imperfect delirium assessment. We aimed to describe robust estimates of delirium occurrence (incidence and prevalence) and risk factors in an acute stroke unit (ASU). Methods: We collected data from sequential admissions to our University Hospital ASU over a 20 week period (Feb-July 2016). The only exclusion was where the clinical team felt that any form of assessment was inappropriate. We aimed to perform cognitive assessments at 48 hours post stroke. Cognitive assessments were based on mini Montreal Cognitive Assessment (m-MoCA) and GP-Cog informant interview to assess for pre-stroke dementia. We assessed for delirium based on DSM-V criteria. We described univariable and multivariable associations with delirium occurrence. Results: Across the study period, 184 strokes were admitted; median age 71 years (IQR:61-79). Some form of cognitive assessment was available for 178 (97%). In total. 152 had evidence of cognitive impairment on m-MOCA, 55 (31%) met criteria for delirium and 25 (15%) had pre-stroke dementia. Significant univariable associations with delirium were:age and pre-existing cognitive decline. On logistic regression:age, history of drug or alcohol misuse and pre-stroke mRS were all independently associated with delirium. Discussion: In an unselected ASU population a substantial proportion will have cognitive impairment based on screening. Delirium is common and contributes to this cognitive problems seen in acute stroke. Independent associations with delirium occurrence were identified but were non-modifiable. Our results have implications for policy and practice. As post-stroke cognitive impairment is multifactorial, screening delirium and pre-existing cognitive issues should form part of the initial assessment.

scholarly journals Associations between stroke severity, aphasia severity, lesion location, and lesion size in acute stroke, and aphasia severity one year post stroke

Aphasiology ◽  
2021 ◽  
pp. 1-23
Author(s):  
Hedda Døli ◽  
Wenche Andersen Helland ◽  
Turid Helland ◽  
Halvor Næss ◽  
Håkon Hofstad ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Lesion Size ◽  
Stroke Severity ◽  
Lesion Location ◽  
Post Stroke ◽  
One Year

scholarly journals Gambaran dislipidemia pada pasien stroke akut di Rumah Sakit Umum Daerah Arifin Achmad Provinsi Riau periode Januari-Desember 2019

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dimas Pramita Nugraha ◽  
Eka Bebasari ◽  
Sahwal Sahputra
Keyword(s):  
Ischemic Stroke ◽  
High Density Lipoprotein ◽  
Acute Stroke ◽  
General Hospital ◽  
Normal Level ◽  
Hemorrhagic Stroke ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Cross Sectional

Abstrak. Stroke adalah penyakit gangguan fungsional otak yang timbul mendadak dan berlangsung lebih dari 24 jam atau berakhir dengan kematian tanpa diketahui penyebab yang jelas selain gangguan vaskuler. Stroke secara umum diklasifikasikan menjadi stroke iskemik atau stroke non hemoragik dan stroke hemoragik. Salah satu faktor risiko terjadinya stroke adalah dislipidemia. Tujuan penelitian ini adalah untuk mengetahui gambaran dislipidemia pada pasien stroke akut di RSUD Arifin Achmad Provinsi Riau Periode Januari–Desember 2019. Desain penelitian yang digunakan adalah penelitian deskriptif  dengan rancangan cross sectional menggunakan data sekunder rekam medis pasien stroke akut di  RSUD Arifin Achmad Provinsi Riau  Periode Januari-Desember 2019 dengan jumlah sampel sebanyak 103 kasus. Hasil penelitian menunjukkan stroke banyak terjadi pada jenis kelamin laki-laki yaitu 63 orang (61,2%). Usia terbanyak terjadi pada rentang usia 51-65 tahun sebanyak 54 (52,4%). Jenis stroke terbanyak adalah stroke hemoragik yaitu 59 orang (57,3%). Kadar kolesterol total terbanyak pada  rentang normal yaitu sebanyak 46 orang (44,7%). Kadar High Density Lipoprotein (HDL)  terbanyak pada rentang normal yaitu sebanyak 49 orang (47,6%). Kadar Low Density  Lipoprotein (LDL) terbanyak pada kategori tinggi sebanyak 26 orang (25,2%) dan normal tapi berisiko sebanyak 26 orang (25,2%). Kadar trigliserida terbanyak pada kategori normal sebanyak 65 orang (63,1%). Terdapat 17 orang (16,5%) pasien dislipidemia, sebanyak 9 orang (52,9%) adalah stroke iskemik. Kesimpulan dari penelitian ini adalah dislipidemia lebih banyak terjadi pada stroke iskemik disbanding stroke hemoragik.Kata kunci:  dislipidemia, stroke, stroke non hemoragikAbstract. Stroke is a disease of the brain functional disorders that arises suddenly and lasts more than 24 hours or ends in death situation without a known cause other than vascular disorders. Strokes are generally classified into ischemic stroke (non-hemorrhagic) and hemorrhagic stroke, One of the risk factors of stroke is dyslipidemia. The aim of this study was to describe dyslipidemia in acute stroke patients at Arifin Achmad Regioal General Hospital of Riau Province in January to December 2019. This was a descriptive study design with cross sectional study method by using secondary data of the acute stroke patient's medical record at Arifin Achmad Regional General Hospital of Riau Province in January to December 2019 with a total sample of 103 cases. The results show that stroke is more common in male that is 63 (61.2%) cases, and the majority happened within the 51-65 years age groups with 54 (52.4%) cases. Most of the stroke’s type in patients were hemorrhagic stroke in 59 (57.3%) cases. Highest total of cholesterol level remains normal in 46 (44.7%) cases. The majority of patients still presented with normal level of High Density Lipoprotein (HDL) in 49 (47.6%) cases. In contrary, most patients presented with high level of Low Density Lipoprotein (LDL) in 26 (25.2%) cases and also with normal level but considered as high-risk group in  26 (25.2%) cases. Most patients still presented with normal level of triglyceride in 65 (63.1%) cases. There were 17 (16.5%) cases of patient with dyslipidemia, 9 of them were considered as ischemic stroke (52.9%). The conclusion of this study is that dyslipidemia commonly occurs in ischemic stroke types compared to a hemorrhagic stroke.Keywords: dyslipidemia, stroke, non hemorrhagic stroke

scholarly journals Correlation of blood glucose levels, HbA1c, hemoglobin and leukocytes with outcome on acute stroke

2019 ◽  
Vol 7 (5) ◽  
pp. 1430
Author(s):  
Meiriani . ◽  
Yuneldi Anwar ◽  
Puji Pinta Omas Sinurat
Keyword(s):  
Ischemic Stroke ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Cross Sectional Study ◽  
P Value ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels

Background: Diabetes and higher HbA1c level have increased the incidence of stroke. Hemoglobin levels both high and low are associated with poor outcomes. Leukocytes play an important role in the initiation of the atherosclerosis process.Methods: This was a cross-sectional study with a sample size of 62 people selected by non-random sampling method on a consecutive basis, patients with acute stroke were taken blood to measure blood glucose levels, HbA1c, Hb and Leucocytes when entering the hospital room. Outcomes were assessed using NIHSS and MRS. The calculation of NIHSS and MRS scores was performed on the first day of admission and the fourteenth day. To analyze the correlation of blood sugar levels during HbA1c, Hb and leukocytes in acute stroke, this study used Spearman's correlation test. The p value <0.05 was considered statistically significant.Results: The study subjects of 62 acute stroke patients (acute ischemic stroke 31 people and 31 people hemorrhagic stroke). Acute stroke patients were consisted of 38 men (61.3%) and 24 women (38.7%). Of 31 people with hemorrhagic stroke, there were 16 men (51.6%) and 15 women (48.4%), ischemic stroke patients were consisted of 22 people (71, 0%) and women were 9 people. Spearrman repair test showed no symptoms between blood glucose levels, HbA1c, Hemoglobin and leukocytes with outcomes in acute stroke.Conclusions: There was no significant association between blood glucose levels, HbA1c, hemoglobin and leukocytes with outcomes in acute stroke.

scholarly journals Karakteristik dan Periode Kekambuhan Stroke pada Pasien dengan Stroke Berulang di Rumah Sakit Margono Soekardjo Purwokerto Kabupaten Banyumas

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Meida Laely Ramdani
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Low Income ◽  
Recurrent Stroke ◽  
Sampling Technique ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke ◽  
Duration Of Illness

Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion:  Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment. Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion:  Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment.

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