الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Introduction : Stroke is the third most common cause of death and the most common cause of adult disability. The definition of stroke is clinical, and laboratory studies including brain imaging are used to support the diagnosis. This disease accounts for more disability , more cost in cure and more lost income than any other neurological diseases in this age group. The brain normally derives its energy from the oxidative metabolism of glucose. Because there are negligible stores of glucose in the brain, when CBF falls and the brain becomes ischemic, a series of neurophysiological and functional changes, which are dependent on the oxidative metabolism of glucose to provide energy in the form of ATP, occur at various thresholds of flow before infarction . Subjects & Methods: The present study includes 40 Egyptian patients with ischemic cerebral stroke and 40 control subjects. Patients were subjected to clinical and radiological (computed tomography, conventional brain MRI and MRS) examinations. Conventional brain MRI allows precise localization of the region of infarction and is very sensitive to early changes of cerebral ischemia. Magnetic resonance spectroscopy (MRS) is a noninvasive in vivo method that allows the investigation of biochemical changes in humans. Results The application of MRS to the study of stroke has made possible dynamic studies of intracellular metabolism of cerebral ischemia. The majority of the stroke studies have been carried out using proton [1H]MRS which allows the detection of Nacetyl aspartate (NAA), a neuronal marker. [1H]MRS changes in humans demonstrate that after an infarct, lactate appears, while NAA, total creatine and choline are reduced compared to the contralateral hemisphere. The larger the infarct volume, the worse is the outcome, and patients with small infarct volume had a better outcome than patients with larger infarct volume.. Conclusions : The addition of NAA concentration to infarct volume allows a better prediction of patients morbidity , than either the NAA concentration or infarct volume alone. Major advances in the treatment of acute stroke require the accurate prediction of the mortality of stroke patients. Because each MRS examination adds only 7 minutes to a standared brain MRI and provides much more information about the severity of ischemia, 1HMRS may have a useful role in the assessment of stroke patients. Recommendations : It is of utmost benefit to correlate the risk factors of stroke with brain metabolites, especially the decrease of these metabolites in non infarct area & to follow up these changes and whether it is permanent or temporary changes.