Stroke is one of the leading causes of morbidity and mortality worldwide and represents a major public health burden, particularly in low- and middle-income countries.[1] It is defined as the sudden onset of focal neurological deficit attributable to a vascular cause lasting more than 24 hours or leading to death.[2] Among all stroke types, acute ischemic stroke accounts for nearly 80–85% of cases, resulting from an interruption of cerebral blood flow due to thrombosis or embolism.[3]

The global incidence of stroke has been increasing, with an estimated 12 million new cases reported annually, contributing significantly to long-term disability and healthcare costs.[4] In India, the burden of stroke is rising due to demographic transition, increasing life expectancy, and a higher prevalence of vascular risk factors.[5] Early identification of clinical patterns and radiological features is essential for prompt diagnosis and effective management.

Neuroimaging plays a pivotal role in the evaluation of acute ischemic stroke. CT (Computed Tomography) remains the first-line imaging modality due to its availability and rapid acquisition, primarily used to exclude haemorrhage.[6] MRI (Magnetic Resonance Imaging), especially DWI (Diffusion-Weighted Imaging), is more sensitive in detecting early ischemic changes and helps in identifying the ischemic penumbra, which is crucial for therapeutic decisions.[7]

Several modifiable and non-modifiable risk factors contribute to the development of ischemic stroke. Hypertension is the most significant modifiable risk factor, accounting for a large proportion of stroke cases.[8] Other important risk factors include diabetes mellitus, dyslipidemia, smoking, atrial fibrillation, and coronary artery disease.[9] Studies have shown that nearly 90% of stroke risk is attributable to these modifiable factors.[4]

Clinico-radiological correlation is important in understanding the pattern, location, and severity of infarction, which in turn influences prognosis and management strategies.[10] Common sites of infarction include the internal capsule, basal ganglia, and cortical regions supplied by major cerebral arteries.[11] The clinical presentation varies depending on the vascular territory involved, with hemiplegia, speech disturbances, and sensory deficits being the most frequent manifestations.[12]

 AIMS AND OBJECTIVES

The aim of this study was to evaluate the clinico-radiological profile and analyze the risk factors associated with acute ischemic stroke in a tertiary care center. It sought to assess the demographic characteristics of affected patients, along with their clinical presentation and neurological deficits at the time of admission. The study also aimed to evaluate radiological findings, including the site and extent of infarction using CT and MRI. In addition, major risk factors such as hypertension, dyslipidemia, and cardiac abnormalities were identified, with particular emphasis on determining the association of hypertension-its duration and blood pressure levels at presentation-with the occurrence and severity of acute ischemic stroke.

Study Design

This was a hospital-based cross-sectional study conducted in the Department of Medicine at Adichunchanagiri Hospital and Research Centre, BG Nagara (571448), over a period from October 2018 to June 2020. The study included 50 patients diagnosed with acute ischemic stroke who were admitted to the tertiary care center during the study period.

Inclusion and Exclusion Criteria

Patients aged more than 40 years who were admitted with a clinical diagnosis of acute ischemic stroke and had radiological confirmation on CT scan and/or MRI were included. Both male and female patients with first-ever or recurrent ischemic stroke were considered, irrespective of associated risk factors. Patients with haemorrhagic stroke, traumatic brain injury, stroke mimics, incomplete clinical or radiological data, or those unwilling to participate were excluded.

Sample Size

A convenience sample of 50 patients meeting the inclusion criteria was enrolled consecutively during the study period from October 2018 to June 2020. The study was conducted after obtaining approval from the Institutional Ethics Committee of Adichunchanagiri Hospital and Research Centre. Informed verbal consent was obtained from all patients or their relatives prior to enrolment.

Data Collection Procedure

Detailed clinical history was collected using a predesigned structured proforma. Information regarding demographic details, presenting complaints, history of transient ischemic attack, hypertension (including duration), diabetes mellitus, dyslipidemia, and cardiac conditions was recorded. A comprehensive general, cardiovascular, and neurological examination was performed. Blood pressure was recorded at admission. All patients underwent CT scan of the brain; MRI was performed when indicated. Laboratory investigations included complete hemogram, renal function tests, lipid profile, urinalysis, ECG, and echocardiography.

Statistical Analysis

Descriptive statistics, including mean, standard deviation, frequencies, and percentages, were used to summarize variables. Associations between risk factors and clinical or radiological parameters were analyzed using the Chi-square test for categorical variables. A p-value of less than 0.05 was considered statistically significant.

Table 1: Age Distribution of Study Population

Table 1 illustrates that the majority of patients belonged to the 60–79 years age group (64%), indicating a higher prevalence of stroke among the elderly population. The mean age was 65.88 ± 10.96 years.

Table 2: Gender Distribution

Table 2 shows a slight male predominance (54%) in acute ischemic stroke cases, consistent with published literature.

Table 3: Clinical Features at Presentation

Table 3 demonstrates that hemiplegia/hemiparesis was the most common clinical presentation (64%), followed by combined neurological deficits indicating severe stroke (22%).

Table 4: Echocardiographic Findings

Table 4 shows that LVH (Left Ventricular Hypertrophy) was the most common cardiac abnormality (30%), followed by diastolic dysfunction (14%) and atrial fibrillation (10%).

Table 5: Lipid Profile Status

Table 5 highlights that a large majority of patients (76%) had dyslipidemia, indicating its strong association with ischemic stroke.

Table 6: Radiological Distribution of Infarct (CT/MRI Brain)

Table 6 demonstrates that the internal capsule was the most common site of infarction (66%), followed by basal ganglia (16%) and thalamus (10%), indicating a predominance of deep brain infarcts. Posterior fossa lesions (cerebellum and brainstem) were detected only on MRI.

Table 7: Distribution of Major Risk Factors among Study Population

Cardiac abnormalities include left ventricular hypertrophy, diastolic dysfunction, ischemic heart disease, atrial fibrillation, and left atrial thrombus. Table 7 illustrates the distribution of major risk factors among the study population. Hypertension was present in all patients (100%), as it formed the primary inclusion criterion. Dyslipidemia was observed in 76% of patients, indicating a strong association with ischemic stroke. Cardiac abnormalities were present in 68% of cases, highlighting the significant contribution of cardiovascular conditions in the pathogenesis of stroke. These findings emphasize the role of multiple modifiable risk factors in the development of acute ischemic stroke.

Acute ischemic stroke remains a major cause of morbidity and mortality worldwide, particularly affecting the elderly population. In the present study, the majority of patients belonged to the 60–79 years age group with a mean age of 65.88 ± 10.96 years. This finding is comparable to studies by Dewan KR et al.[13] (67.15 ± 12.58 years) and Naik M et al.[10] (67.04 ± 13.39 years), highlighting that stroke predominantly affects the elderly due to progressive atherosclerosis and accumulation of vascular risk factors.[3]

In the present study, there was a slight male predominance (54%), consistent with findings from Soliman RH et al.[14] who reported 53.9% male patients. This may be attributed to higher exposure to risk factors such as hypertension, smoking, and occupational stress among males.[15]

Clinically, hemiplegia/hemiparesis was the most common presentation (64%), followed by combined motor, sensory, and speech deficits (22%). These findings are comparable to the study by Kaur G et al.[12] where hemiplegia was observed in 69% of patients. This consistency reflects common involvement of motor pathways in ischemic stroke, particularly the corticospinal tract passing through the internal capsule.[16]

Cardiac abnormalities were frequently observed, with left ventricular hypertrophy (30%) being the most common finding. This is comparable to Amin H et al.[17] who reported LVH in 25% of stroke patients. Atrial fibrillation was present in 10% of cases, aligning with findings from Marini C et al.[18] emphasizing the role of cardioembolic mechanisms in ischemic stroke.

Dyslipidemia was observed in 76% of patients, consistent with Zhao P et al.[19] who reported approximately 70% dyslipidemia in stroke patients. Elevated cholesterol and LDL levels contribute to atherosclerotic plaque formation, thereby increasing the risk of cerebral infarction.[20]

Radiologically, the internal capsule was the most commonly involved site (66%), followed by basal ganglia (16%) and thalamus (10%). These findings are in agreement with Naik M et al.,[10] where deep brain structures were commonly affected. This distribution reflects the vulnerability of small penetrating arteries to occlusion, especially in hypertensive patients.[11]

The findings of this study emphasize that acute ischemic stroke is strongly associated with modifiable risk factors such as hypertension, dyslipidemia, and cardiac abnormalities. The clinico-radiological correlation observed is consistent with existing literature and highlights the importance of early identification and management of these risk factors to reduce the burden of stroke.

Acute ischemic stroke predominantly affects the elderly population and commonly presents with motor deficits such as hemiplegia. Radiologically, deep brain structures like the internal capsule and basal ganglia are most frequently involved. Hypertension, dyslipidemia, and cardiac abnormalities are the major associated risk factors. Early identification and effective management of these modifiable risk factors are essential to reduce the burden and adverse outcomes of stroke.

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