Clinical profile of cerebrovascular accident patients with special reference to serum homocysteine level

Background: Cerebrovascular accident (CVA) remains a major cause of morbidity and mortality worldwide. There is growing evidence that high homocysteine level contribute to the pathogenesis of ischemic stroke. High hohmocysteine levels are associated with increased risk of cardiovascular and cerebrovascular disease, although there are few studies that show no increase in risk, and there is still debate as to the strength and validity of the association. This study has been undertaken to correlate the serum homocysteine level in patients of cerebrovascular accident. Materials and methods: This study comprised of 100 patients of cerebrovascular accident admitted with acute onset of neurological deficit which are radiologically diagnosed. The diagnosis of cerebrovascular accident was made on the basis of history and clinical examination. We did CBC with ESR, renal function test, liver function test, serum homocysteine level, RBS, Fasting lipid profile, vitamin B12, urine routine analysis, HIV, CT scan Brain/ MRI Brain, ECG, 2D ECHO, Carotid Doppler if required, ANA / RA factor and any specific investigation if indicated. Results: Highest no of patients were in 5th and 6th decades of life with highest mean serum homocysteine level. Males were more affected with CVA than females and the mean serum homocysteine level was also higher in males. Urban population has higher homocysteine level than rural. Most common presenting symptom of CVA in the present study was hemiplegia. Convulsion was more associated with hemorrhagic CVA rather than ischemic CVA. Hypertension is one of the major risk factors for CVA. The mean homocysteine was higher in vegetarian population. Out of 72 patients having raised S. homocysteine level, 38 patients had vitamin B12 deficiency. Conclusion: Hyperhomocysteinemia is an independent risk factor for CVA. Urban lifestyle is associated with higher incidence of CVA and higher homocysteine level. Homocysteine estimation should be included as a routine laboratory test for persons with cerebrovascular risk factors. Plasma vitamin B12 concentration is inversely associated with s. homocysteine concentration. Treatment of hyperhomocysteinemia with vitamin B12 supplements will reduce homocysteine level and ultimately reduce risk of CVA.