• Aleksandra Angelova University Clinic for Neurology, Clinical Center “Mother Theresa”, Skopje, R.North Macedonia
  • Glorija Gashpar PHI Specialized Hospital for Geriatric and Palliative Medicine "13th November", Bitola, R. North Macedonia
  • Anita Arsovska University Clinic of Neurology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia


Stroke remains the second leading cause of death and the leading cause of disability worldwide, with its incidence and mortality differing between countries. Even though there has been a substantial decrease in the burden of stroke in high-income countries, around 70% of stroke cases occur in low or middle-income countries, with great negative effect on the system. Although risk factors are well known, it is still unclear to which extent each of them impacts the neurologic deficit and the level of consciousness of the patient.The aim of this study is to identify the influence of 6 common stroke risk factors - hypertension, atrial fibrillation, cardiomyopathy, diabetes mellitus, previous stroke or transient ischemic attack and dyslipidemia on the neurologic deficit quantified by National Institutes of Health Stroke Scale and the level of consciousness quantified by Glasgow Coma Scale. Material and methods: For this purpose, existing records of 157 patients from October 2019 to October 2020 were analysed.The study showed that atrial fibrillation (p=0.048), cardiomyopathy (p=0.024) and previous stroke or transient ischemic attack (p=0.03) significantly influence the mean National Institutes of Health Stroke Scale score, while atrial fibrillation (p=0.0067) and dyslipidemia (p=0.029) significantly influenced mean Glasgow Coma Scale scores. This emphasizes the need of proper management of risk factors, especially higlighting stroke prevention in atrial fibrillation.

Keywords: stroke, risk factors, neurologic deficit, level of consciousness.


1. Fernando Lanas et al. Facing the stroke burdain worldwide. The Lancet Global Health, 2021.
2. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O'Donnell M. Global and Regional Burden of Stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. The Lancet. 2014 Jan 24;383(9913):245-55.
3. And Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, Barker-Collo S, Moran AE, Sacco RL, Truelsen T, Davis S. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015 Oct 28;45(3):161-76.
4. Dušica Simić-Panić, Ksenija Bošković, Marija Milićević, Tamara Rabi Žikić, Mina Cvjetković Bošnjak, Snežana Tomašević-Todorović, and Mirjana Jovićević. The Impact of Comorbidity on Rehabilitation Outcome After Ischemic Stroke. Acta Clin Croat. 2018 Mar; 57(1): 5–15.
5. Rigler SK, Studenski S, Wallace DM, Reker DM, Duncan PW. Comorbidity adjustment for functional outcomes in community-dwelling older adults. Clin Rehabil. 2002;16(4):420–8.
6. Katie I. Gallacher, Bhautesh D. Jani, Peter Hanlon, Barbara I. Nicholl, Frances S. Mair. Multimorbididy in stroke. Stroke AHA. 11 Apr 2019. 2019;50:1919–1926.
7. Thanh G. Phan, Benjamin B. Clissold, Henry Ma, John Van Ly and Velandai Srikanth on Behalf of the VISTA-Acute Collaborators. Predicting Disability after Ischemic Stroke Based on Comorbidity Index and Stroke Severity—From the Virtual International Stroke Trials Archive-Acute Collaboration. Front. Neurol., 19 May 2017.
8. Shobhit Jain; Lindsay M. Iverson.Glasgow Coma Scale. June 20, 2021 and Gennarelli TA, Champion HR, Copes WS, Sacco WJ. Comparison of mortality, morbidity, and severity of 59,713 head injured patients with 114,447 patients with extracranial injuries. J Trauma. 1994 Dec;37(6):962-8.
9. Carlene M M Lawes, Derrick A Bennett, Valery L Feigin, Anthony Rodgers. Blood pressure and stroke: an overview of published reviews. 2004 Feb 19.PMID: 14976329 DOI: 10.1161/01.STR.0000116869.64771.5A
10. Shinton R, Beevers G: Meta-analysis of relation between cigarette smoking and stroke. Br Med J 1989;298:789-794 and Adviye Ergul, Sherif Hafez, Abdelrahman Fouda, and Susan C. Fagan. Impact of Comorbidities on Acute Injury and Recovery in Preclinical Stroke Research: Focus on Hypertension and Diabetes. 2016 Mar 30. doi: 10.1007/s12975-016-0464-8.

11. Rasha H. Soliman, Mohammed I. Oraby, Mohammed Fathy & Alaa M. Essam. Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery.25 April 2018.
12. Jie Li, Deren Wang,Wendan Tao,Wei Dong, Jing Zhang, Jie Yang,and Ming Liu. Early consciousness
13. disorder in acute ischemic stroke: incidence, risk factors and outcome. BMC Neurol. 2016; 16: 140.
14. MetinKarataşMD, AyşeDilekMD, HilalErkanMD, NurYavuzMD, SeyhanSözayMD, NafizAkman. Functional outcome in stroke patients with atrial fibrillation. Archives of Physical Medicine and Rehabilitation. August 2000.
15. Gustavo Saposnik 1, David Gladstone, Roula Raptis, Limei Zhou, Robert G Hart, Investigators of the Registry of the Canadian Stroke Network (RCSN) and the Stroke Outcomes Research Canada (SORCan) Working Group. Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. STROKE AHA. Jan 2013. PMID: 23168456 DOI: 10.1161/STROKEAHA.112.676551.
16. Dulli DA, Stanko H, Levine RL. Atrial fibrillation is associated with severe acute ischemic stroke. Neuroepidemiology. 2003;22:118–23. 10.1159/000068743.
17. Kim K. Relation of Stroke Risk Factors to Severity and Disability after Ischemic Stroke. Korean J Stroke. 2012 Dec;14(3):136-141.
18. Peter Appelros, Ingegerd Nydevik, Ake Seiger, Andreas Terént. Predictors of severe stroke: influence of preexisting dementia and cardiac disorders. Stroke. 2002 Oct;33(10):2357-62.
19. H J Lin, P A Wolf, M Kelly-Hayes, A S Beiser, C S Kase, E J Benjamin, R B D'Agostino. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996 Oct;27(10):1760-4. doi: 10.1161/01.str.27.10.1760.
20. Lamassa M, Di Carlo A, Pracucci G, Basile AM, Trefoloni G, Vanni P, Spolveri S, Baruffi MC, Landini G, Ghetti A. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project) Stroke. 2001;32(2):392–398. doi: 10.1161/01.STR.32.2.392.
21. Adrià Arboix. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015 May 16;3(5):418-29. doi: 10.12998/wjcc.v3.i5.418.
22. Shintaro Haruki, Yuichiro Minami, and Nobuhisa Hagiwara. Stroke and Embolic Events in Hypertrophic Cardiomyopathy, Risk Stratification in Patients Without Atrial Fibrillation. AHA Stroke. 3 Mar 2016. 47:936–942.
23. Atalay A, Turhan N. Determinants of length of stay in stroke patients: a geriatric rehabilitation unit experience. Int J Rehabil Res. 2009;32:48–52. 10.1097/MRR.0b013e32830d3689.
24. Adviye Ergul,Sherif Hafez,Abdelrahman Fouda, and Susan C. Fagan. Impact of Comorbidities on Acute Injury and Recovery in Preclinical Stroke Research: Focus on Hypertension and Diabetes. Transl Stroke Res. 2016 Aug; 7(4): 248–260.
25. Mizrahi EH, Waitzman A, Arad M, Adunsky A. Gender and functional outcome of elderly ischemic stroke patients. Arch Gerontol Geriatr. 2012;55:438–41. 10.1016/j.archger.2011.11.002.
26. Werner Hacke, Jean-Pierre Bassand , Saverio Virdone, A John Camm, David A Fitzmaurice, Keith Aa Fox, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Karen S Pieper, Alexander Gg Turpie, Martin van Eickels, Freek Wa Verheugt, Ajay K Kakkar 3, GARFIELD-AF Investigators. Prior stroke and transient ischemic attack as risk factors for subsequent stroke in atrial fibrillation patients: A report from the GARFIELD-AF registry. Int J Stroke. 2020 Apr;15(3):308-317.
27. Lynda D. Lisabeth, Jennifer K. Ireland, Jan M.H. Risser, Devin L. Brown, Melinda A. Smith, Nelda M. Garcia, and Lewis B. Morgenstern. Stroke Risk After Transient Ischemic Attack in a Population-Based Setting. Stroke. 2004;35:1842–1846.
28. Amarenco P., Bogousslavsky J., Callahan A., III., Goldstein L. B., Hennerici M., Rudolph A. E., et al. (2006). High-dose atorvastatin after stroke or transient ischemic attack. N. Engl. J. Med. 6, 549–559. 10.1016/j.jvs.2006.10.008.
29. C Baigent, A Keech, P M Kearney, L Blackwell, G Buck, C Pollicino, A Kirby, T Sourjina, R Peto, R Collins, R Simes, Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005 Oct 8;366(9493):1267-78.
30. Grau AJ, Weimar C, Buggle F, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke the German stroke data Bank. Stroke. 2001;32(11):2559–66.
31. Lucas Restrepo,a,Oh Young Bang, Bruce Ovbiagele, Latisha Ali, Doojin Kim, David S. Liebeskind,Sidney Starkman, Fernando Vinuela, Gary R. Duckwiler,Reza Jahan, and Jeffrey L. Savera. Impact of Hyperlipidemia and Statins on Ischemic Stroke Outcomes after Intra-ArterialFibrinolysis and Percutaneous Mechanical Embolectomy. Cerebrovasc Dis. 2009 Sep; 28(4): 384.
32. Schmidt M, Jacobsen JB, Johnsen SP, Bøtker HE, Sørensen HT. Eighteen-year trends in stroke mortality and the prognostic influence of comorbidity.Neurology. 2014; 82:340–350. doi: 10.1212/WNL.0000000000000062.
33. Altafi D, Khotbesara M, Khotbesara M, Bagheri A. A comparative study OF NIHSS between ischemic stroke patients with and without risk factors. Tech J Eng Appl Sci. 2013;3(17):1954–7.
How to Cite
ANGELOVA, Aleksandra; GASHPAR, Glorija; ARSOVSKA, Anita. NEUROLOGIC DEFICIT AND LEVEL OF CONSCIOUSNESS IN PATIENTS AFTER STROKE: CORRELATION WITH RISK FACTORS. Journal of Morphological Sciences, [S.l.], v. 4, n. 3, p. 183-197, dec. 2021. ISSN 2545-4706. Available at: <>. Date accessed: 23 apr. 2024.