Background: Stroke is the most common reason for disability and the third cause of mortality in the world per year. Metabolic syndrome (MetS) is known as an independent risk factor of coronary artery disease and stroke. Aim of the work: To investigate the relationship between metabolic syndrome and risk of ischemic stroke, whether stroke patients with metabolic syndrome differ from other ischemic stroke patients in demographic variables, stroke presentation, stroke severity, neuroimaging, and prognosis. Patients and methods: This is a hospital-based, prospective observational study. The study population constituted of patients with first-ever atherothrombotic ischemic stroke who were admitted to the neurology department within 6 months (between January 1 st , 2016 and July 1 st , 2016). Patients were subjected to full neurological examination, assessment of stroke severity using National Institute of Health Stroke Scale (NIHSS), screening for MetS components, brain imaging, transthoracic echocardiography, and carotid duplex. Results: MetS was of higher frequency in atherothrombotic stroke patients compared to previous studies, more in females and older age. MetS with diabetes mellitus (DM) patients had the worst clinical presentation and the worst in-hospital outcome. High high-density lipoprotein cholesterol (HDL-C) was the predictor for worse clinical presentation. Conclusion: The higher the number of MetS components, the higher the risk of ischemic stroke. High HDL-C was the predictor for worse clinical presentation. Thus, diagnosing and adequately managing MetS is an important step in preventing cerebrovascular disease.

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