FREQUENCY OF HYPERHOMOCYSTEINEMIA AND ITS PROGNOSTIC OUTCOME IN FIRST-EVER ACUTE STROKE PATIENTS AS SEEN IN THE UNIVERSITY OF BENIN TEACHING HOSPITAL
Background: Acute stroke being a major cause of neurological admissions with its
unacceptably high morbidity and mortality, the need for more research into new and emerging
risk factors has gained a lot of attention. Hyperhomocysteinemia is considered a possible
modifiable risk factor for acute stroke. The role of hyperhomocysteinemia in acute stroke in
Africans is still uncertain. The aim of this study was to determine the frequency and short-term
consequences of hyperhomocysteinaemia in patients with first-ever acute strokes in a Nigerian
Methods: This was a prospective case-control study of a total of 298 subjects (148 stroke cases
and 150 controls). The cases were admitted first-ever acute stroke patients, presenting within
48 hours of onset of stroke symptoms and compared with age and sex matched controls.
Clinical history and neurological assessments were recorded at presentation and the total
plasma homocysteine level was also determined in both cases and controls. Stroke severity was
determined by the Canadian Neurological Scale (CNS), and outcome at 6 weeks was
determined by the Modified Rankin Score (mRS).
Results: The stroke cases were 92(62.2%) ischemic and 56(37.8%) hemorrhagic. The mean
age of the cases was 65±12.6 years and that of the controls was 62±20.9 years (t=1.703;
p=0.955). The female: male ratio was 1:1.03. The mean CNS score at presentation was 4.9±2.0
for ischemic strokes and 4.4±2.9 for hemorrhagic strokes. The mean total plasma homocysteine
level of 7.50±4.06µmol/l for all strokes was not different significantly from that of the controls
of 7.93±4.26µmol/l. (p=-0.902). However, the mean total plasma homocysteine level of
8.05±4.79µmol/l for ischemic strokes was significantly higher than that of Hemorrhagic strokes
Hyperhomocysteinaemia defined by homocysteine levels above the mean +2 SD of controls
(16.5µmol/l) was present in 10(6.8%) of the stroke cases (all ischemic and none in Hemorrhagic) and in 9(6%) of the controls (p=0.789). Plasma homocysteine levels correlated significantly with stroke outcome at 6 weeks as measured by the mRS (r=0.257, p=0.002), and hyperhomocysteinaemia also predicted poorer stroke outcome in ischemic stroke (p<0.001, OR=60.64).
Conclusion: This study showed that though homocysteine level was not significantly elevated
in subjects presenting with acute stroke for the first time compared with age and sex matched
controls, it was however found to be higher in ischemic compared to hemorrhagic strokes and
notably, hyperhomocysteinaemia was a significant determinant of poor short term stroke
outcome in ischemic stroke.