A cerebrovascular accident has also termed a stroke. Stroke is a disease of the vascular system of the brain. It is the second leading cause of death worldwide, causing 6.2 million deaths in 2011 [1-3]. Several population-based surveys on stroke were conducted from different parts of India. The ratio of cerebral infarct to haemorrhage was 2.21. Hypertension was the most important risk factor. Stroke represented 1.2% of total deaths in India. Various risk factors have been implicated in the pathogenesis of CVA, divided into mainly two types, non-modifiable risk factors such as Age, Gender, Race. And modifiable risk factors (e.g.hypertension, carotid bruit/stenosis, cardiac disease, diabetes, dyslipidemia, tobacco, alcohol consumption, obesity).[1-3].

Cerebrovascular accidents are classified into two main types: Ischaemic Stroke and cerebral haemorrhage. Brain ischemia results from the occlusion of cervicobrachial vessels or hypoperfusion caused by various processes as atherothrombosis, embolism, or hemodynamic abnormalities⁵. In cerebral haemorrhage, there is rupture of a brain vessel causing leakage of blood into the brain parenchyma, cerebrospinal fluid (CSF) spaces around the brain, or both. There are two subcategories of spontaneous intracranial hemorrhages. Intracerebral haemorrhage (ICH) is bleeding in the brain parenchyma itself, and subarachnoid hemorrhage (SAH) refers to bleeding around the brain into the subarachnoid spaces and CSF. [4,5].

Setting Duration and type of study: The study was conducted on 100 patients of a Cerebrovascular accident admitted in the neurology unit of the Department of medicine, G R Medical College, Gwalior, over one year from November 2009 to October 2010 after obtaining Institutional Ethical Committee approval.

Study Design: Longitudinal Study

Inclusion Criteria:

1. Age>18 years of age
2. History of sudden onset neurological deficit with brain imaging showing: Focal/global ischemia or Intracerebral haemorrhage

As shown in chart 2, 91% of the patients were in the age group of > 45, whereas 9% were young stroke (i.e. < 45-year-old). Chart 2 Distribution of the CVA patients according to age (n=100):

Table 1: comparison of uric acid levels based on age

Table no. 1 shows, the mean uric acid level in the age group of < 45 years was 6.49 ± 3.1 mg/dl, and the age group of > 45 years was 8.87 ± 2.6 mg/dl. This is statistically significant. These factors though showing statistical significance, cannot be used for the general population because as age increases, the mean blood pressure also increases, and the lack of age sex-matched group hinders in generalising the findings obtained and thus concluding that age and sex are independent risk factors on their own in cases of CVA.

Table 2: Demographic profile of CVA patients at diagnosis

Table No. 2 shows, the mean MAP at the time of presentation was 119.9 ±19.5mmHg, and the range was (83.3 – 190 mmHg), and the mean random blood sugar levels were 145 + 72 mg/dl and the range was (50– 356). The mean serum uric acid levels were 8.6 ± 2.7mg/dl, with the range being (1.1 – 15). Serum cholesterol levels were 191 ±

Verdecchia et al. and colleagues found that serum uric acid was a powerful predictor of CV disease and all-cause mortality. Serum uric acid measured within the first 24 hours after hospital admission for acute stroke is an independent marker of poor outcome and can predict future vascular events. Uric acid levels independently predict bad outcomes as defined by death or survival in care (Indicating a poorer functional outcome) at 90 days after the index stroke.

Multiple studies provide strong evidence that elevated uric acid may also bear independent risk factors associated with total and CV mortality. Also, provide strong evidence that an elevated uric acid is dangerous rather than protective in subjects with acute stroke [13]. In the study by Loana Moaza et al., significantly higher serum uric acid values were found in stroke patients who died (9.5 ±3 mg/dl) than patients who survived (6.9±4 mg/dl) stroke.[6,12,13].

Gender distribution of cases among ischemic and haemorrhagic Stroke: Out of the 39 cases of ischemic stroke, the majority were male, i.e. 29 (74.35%) cases were male. And out of the 61 cases of haemorrhagic stroke, 45 (73.77%) were males. In a study by Chamorro, among the number of patients admitted with ischemic stroke, the males outnumbered females. A similar pattern was observed in the present study in cases of ischemic stroke. Out of 100 patients, 23 patients had normal uric acid levels (<7mg/dl). Seventy-seven patients were with elevated uric acid levels. So the prevalence of hyperuricemia (>7mg/dl) amongst stroke patients was 77%According to Mehrpour et al., the prevalence of hyperuricemia in stroke patients was 47.3%. In another study by Rangavenamma et al., the prevalence of ischemic stroke was 25%.[11,14,15].

The prevalence of hyperuricemia (>7mg/dl) amongst stroke patients was 77% in the present study. The serum uric acid values were high among the group of hyperglycemic and hypertensive patients at the time of admission.

There was no significant difference between the levels of uric acid among survivors and non-survivors. Though most of the patients had hyperuricemia, it didn't correlate with inferior outcomes. Further study with a large sample size with a control group is required.