English

Abstract

INTRODUCTION: Despite lot of researches in the field of stroke, accurate prognostication of an acute attack is difficult. Several prognostic factors like site of infarction, size of infarct, size of the vessel involved, Glasgow coma scale, level of cerebral edema, intracranial tension have been found significant in cerebral infarction. Similarly in cases of cerebral hemorrhage, CT calculated volume of hematoma, GCS, site of hemorrhage etc. are important. One of the prognostic indicators which has gained great clinical interest in recent times is the level of serum ferritin. Initially considered only as a stress response to stroke, serum ferritin now is under research as a prognostic indicator. AIMS AND OBJECTIVES: To correlate the levels of serum ferritin with early neurological deterioration and prognosis in patients of acute stroke. MATERIAL AND METHODS: A total of 50 patients of cerebrovascular accident presenting within 48hrs of symptom onset were included in the study and diagnosis of stroke was confirmed by CT scan. In vitro quantitative determination of ferritin in human serum was done within 48 hours of presentation by electro chemiluminescence immunoassay ECLIA in Elecsys and cobas e immunoassay analyser. Neurological assessment was done by Canadian stroke scale. INCLUSION CRITERIA: patients above 18 yrs. of age of both sexes with CT scan confirmed diagnosis of stroke presenting within 48 hrs of symptom onset EXCLUSION CRITERIA: Patient not fulfilling inclusion criteria and with history of recent infection or inflammation in the previous month, with history of malignancy and with anemia. RESULTS: level of serum ferritin has direct correlation with worse prognosis in patients of stroke. The mean level of serum ferritin in the group of clinically improved (87.01) was much lesser compared to the group clinically deteriorated or died (458.7) among patients of ischemic stroke. Similarly in hemorrhagic stroke it was 96.4 in improved group compared to 463.91 in deteriorated. Both the differences were statistically significant (p<0.001) in both types of stroke. CONCLUSION: elevated serum ferritin is strongly associated with early neurological deterioration in patients of stroke and is a definite prognostic marker of acute stroke, ischemic or hemorrhagic an elevated serum ferritin (A marker of iron stores) herald more intensive management protocols and care for the patient as it can predict early neurological deterioration. Iron chelation therapy in acute stroke seems to be a strong theoretical possibility and further studies are required to investigate its role in treatment of stroke.