Acute ischemic stroke is not only a severe disabling cerebrovascular event [1] but also has a great impact on a patient’s life and socioeconomic burden [2]. Although it can be prevented by controlling relevant risk factors [3], its prevalence and incidence remain rising with the aging and atherosclerotic process [4]. It is the comment cause of mortality after coronary artery disease and the commonest cause of chronic adult disability [5].

Acute ischemic stroke results from the sudden loss of blood circulation to an area of cerebral hemispheres leading to irreversible brain injury and neurological deficits persisting for more than 24 hours or until death. It accounts for 80-87% of all strokes [6].

Platelet activation and aggregation are critical in the pathogenesis of acute ischemic stroke. There exist parameters to monitor platelets and their changes, namely: Mean Platelet Volume (MPV), Mean Platelet Count (MPC), Plateletcrit (PCT), and Platelet Distribution Width (PDW) [7]. Together, these are called Platelet indices. Studies have shown that these indices are good indicators of thrombotic states [8].

MPV is a commonly used biomarker of platelet function and activation [9]. Increased MPV has been associated with greater in vitro aggregation in response to ADP and Collagen thereby associated with Myocardial Infraction, Transient Ischemic Attacks, and Ischemic Stroke [10,11,12,13,14]. PDW represents variation in platelet size. Larger PDW also indicates a prothrombotic status [15]. These indices are cost-effective and routinely available.

Since Acute Ischemic stroke is an inflammatory event where the ischemic tissue releases chemokines and cytokines, and recruit peripheral circulating leucocytes [16]. Lymphocytes also infiltrate the ischemic tissues and mediate inflammatory responses [16]. Among the leucocytes, neutrophils were found to be an important mediator and early neutrophilia was found to be associated with larger stroke volumes and poor prognosis [17].

In recent years, the platelet to lymphocyte ratio (PLR) has emerged as a well-accepted biomarker for the assessment of overall inflammatory status. These are simple and cost-effective biomarkers [18].

4. Patients presenting 48hrs. after the onset of neurological symptoms.

For the measurement of indices, a blood sample was collected from the antecubital vein using a 5cc syringe and transferred to an EDTA Test tube and analyzed in an Automated cell counter system within 90 min after collection.

Statistical Analysis: The Data obtained from the hematological investigations was entered in Microsoft Excel and Statistical Package for Social Sciences- SPSS for window version 17 software used for the statistical analysis. The results for each parameter for discrete data and averaged for each parameter were presented in tables.

In the present study, out of 80 patients, 64 were males and 16 were females. Most of the patients were in the 50-70 years age group.

Around 62.5% were in the 45-60 years age group, 26.25% were in the 61-70 years age group. 6.25% were in the <45 years age group and 5% were in the >70 years age group (Table 1).

Table-1: Distribution of patients in different age groups.

Among the risk factors, the order of prevalence is Hypertension > Diabetes Mellitus > Smoking > Alcoholism > Dyslipidaemia. It is depicted in Table 2.

Table-2: Presenting risk factor distribution in the study population.

In the present study, these 80 patients are divided into two groups basing on the National Institute of Health Stroke Scale (NIHSS) score.

When assessing the risk factors for stroke in these patients, the present study showed that Hypertension is the most prevalent risk factor with a percentage of 85 %which is similar to the study conducted by Lok U et al [21] with the prevalence percentage of hypertension as 74% and A.Muscari et al [22] with the prevalence of 84%. Diabetes is the second prevalent cause which was in lines with studies conducted by Lok U et al [21], George J et al [23], and Maydadomac F et al [24]. Dyslipidemia being the least prevalent risk factor in the present study which is 33.7% is similar to the study by Muscari A et al [22] which is 40.1%. The laboratory findings showed that the leukocyte, neutrophil, lymphocyte, and platelet counts did not differ between these two groups of patients. There is no sign of these findings since it is almost similar in both groups with NIHSS < 6 and those with NIHSS > 6. In the present study, there is no sign of MPV concerning Stroke Score which is consistent with the study conducted by Al-Tameemi et al [25] but studies conducted by Butterworth et al [26], Ghahremanfard F et al [27] and Shah P et al [28] have shown significant raise in the MPV. There is also no significance of PDW in the present study which is consistent with the study conducted by Al-Tameemi et al [25] but a study conducted by; Shah P et al [28] has shown significant raise in the PDW. Some studies have shown that there is an increase in these platelet indices in stroke patients in comparison to healthy patients but these indices are not significant to differentiate the stroke severity score. The present study showed a positive relationship between PLR and Stroke Severity Score. There is a significant rise in PLR in patients with NIHSS score >6 i.e., Group 2. This is consistent with a study conducted by Pei Hsun sung et al [29].

The present study has shown a significant difference in the values of PLR about Stroke Severity Score. Therefore, PLR is strongly related to the Stroke Severity Score thereby associated with the prognosis of the stroke.

There is no significant difference in MPV and PDW concerning Stroke Severity Score but these platelet indices can be used as biomarkers in stroke patients since there is a significant rise in these indices in stroke patients to healthy people.