Title: accident is defined as the abrupt onset

 Title: A Study Comparing the level of Serum C- reactive protein in ischemic stroke and hemorrhagic stroke. INTRODUCTION :             Stroke or cerebrovascular accident is defined as the abrupt onset of a neurological deficient that is attributed to a focal vascular cause. The definition of stroke is clinical and laboratory studies including brain imaging are used to support the diagnosis. The clinical manifestations of stroke are highly variable due to the complex anatomy of the brain and its vasculature. Cerebrovascular disease includes some of the most common and devastating disease: ischemic stroke, Hemorrhagic stroke and cerebrovascular anomalies. Ischemic stroke is caused by a reduction in blood flow more than a few seconds. Hemorrhagic stroke is caused by bleeding directly in and around the brain1.

            Atherosclerosis is the process by which cholesterol plaques are formed in medium to large sized arteries. Any endothelial injury leading to the disruption of the plaque can set of an intravascular inflammatory response and thereby initiated the production of c reactive protein. CRP is classified as an acute phase reactant, which means that its levels will rise in response to inflammation. Other common acute phase reactants include the erythrocyte sedimentation rate (ESR), ferritin and platelet count. The CRP typically rises within 6 hours of the start of inflammation2. Recent data suggest that CRP is an inflammatory marker for coronary artery disease and as well as potent and strongest predictor in cardio vascular disease in men and women3.

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Therefore, in this study we compare the levels of CRP in ischemic stroke and hemorrhagic stroke patients to find its significance. OBJECTIVE : 1.      To select the patients with clinical and radiological evidence of stroke.

2.      To estimate the levels of Serum C  reactive protein in the patient 3.      To compare the levels of C reactive protein in ischemic and hemorrhagic stroke    METHODOLOGY : Study design: Prospective, Interventional, Cross sectional study Sample size : 20 patients Study design: Prospective, Interventional.Study method: Questionnaire based study.

Study place: Saveetha Medical College and Hospital, Thandalam, Chennai.Study duration: 2 monthsStudy population: Patients attended  either  Inpatient or Outpatient under General Medicine Department in Saveetha Medical College and Hospital, Thandalam, Chennai. INCLUSION CRITERIA :             All Patients above 40 years of age who have been diagnosed to have focal neurological deficit of acute onset and who have attended Saveetha Medical College Hospital as either inpatient or outpatient during the study period are eligible. EXCLUSION CRITERIA:            Patients with  1.      Acute coronary syndromes2.

      Collagen vascular disorders 3.      Liver and Renal disorder 4.      Patients with recent inflammatory conditions, such as major trauma, surgery or obvious acute infectious disease. 5.      Patients diagnosed with gout, and patients taking drugs that are known to raise serum uric acid levels like diuretics, chemotherapeutic agents, nicotinic acid, ACE inhibitors like losartan 6.      Patients with other recognized risk factors known to increase serum uric acid levels like  leukemia, lymphoma, haemolytic anaemia, psoriasis, hypoparathyroidism were excluded METHOD :1.

         Clearance from the Institutional Ethics Committee will be obtained.2.         All eligible participants will be identified and invited to take part in the study 3.         All eligible participants will be explained the nature of their study and will be given the    choice of enrolling for the study.4.         Patients who provide their written informed consent for the study will be enrolled for the study 5.         All participants will undergo an interview followed by a detailed examination by the investigators. 7.

         All study participants will undergo computerized tomography scan of the brain for diagnosing ischemic stroke or hemorrhagic stroke. 8.         Blood samples were collected from an antecubital vein. The samples were collected into vacuum tubes containing EDTA. After sampling, tubes were centrifuged at 1500×g for 10 min immediately. Aliquots of serum were stored at ?20 ?C, and routine hematology and biochemistry tests were done within a few hours after blood sampling.9.         The first sample should be collected within 48 hours of onset of stroke 10.

      The results will be tabulated and statistical analysis will be done with appropriate parametric and non-parametric tests with p<0.05. LIMITATIONS : 1.         Sample cannot be collected after 48 hours of onset of stroke.2.         Subjects with recent acute inflammatory conditions cannot be included. IMPLICATIONS :The outcome of this study will help us to identify whether C reactive protein can be used as a biomarker and also a predict severity and early outcome measure for differentiating ischemic and hemorrhagic stroke.

The C Reactive protein can be used for monitoring response to therapeutics. REFERENCES : 1. Harrison’s principles of internal medicine 19th edition2. Ridker PM, Silvertown JD. Inflammation, C-reactive protein, and atherothrombosis. J Periodontol 2008; 79(8 Suppl):1544-51.

3. Acta Medica Iranica 2011. 49(3):149-152. Serum C – reactive protein Level as a Biomarker for Differentiation of Ischemic from Hemorrhagic StrokeSeyed Ali Roudbary, Farshid Saadat, Kambiz Forghanparast, Reza Sohrabnejad4. Eikelboom JW, Hankey GJ, Baker RI, McQuillan A, Thom J, Staton J, Cole V, Yi Q.

C-reactive protein in ischemic stroke and its etiologic subtypes. J Stroke Cerebrovasc Dis 2003; 12(2):74-81.5. WakugawaY, Kiyohara Y, Tanizaki Y, Kubo M, Ninomiya T, Hata J, Doi Y, Okubo K, Oishi Y, Shikata K, Yonemoto K, Maebuchi D, Ibayashi S, Iida M. C-reactive protein and risk of first-ever ischemic and hemorrhagic stroke in a general Japanese population: the Hisayama Study. Stroke 2006; 37(1):27-32.

Epub 2005 Nov23.6. Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC. C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ 1996; 312(7038):1061-5.

7. Varoglu AO, Kuyucu M, Demir R, Acemoglu H, Can I, Akcay F. Prognostic values of lesion volume and biochemical markers in ischemic and hemorrhagic stroke: a stereological and clinical study. Int J Neurosci 2009; 119(12):2206-18.  

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