Shock wave therapy is effective in controlling spasticity, increase dorsiflexion active range of motion of ankle and improving ten- meters walking test in stroke patients.

Background: The metabolic syndrome (MetS) is a clustering of vascular risk factors that tend to increase the risk of occurrence of diabetes mellitus type 2 (DMT2), cardiovascular and cerebrovascular ischemic events. The aim of the present study is to investigate the association of extracranial and intracranial arterial atherosclerosis as well as silent brain infarction (SBI) with MetS, thereby determining the potential cerebrovascular atherosclerotic risk of MetS in the Egyptian population. Methods: A case control study was conducted on 50 Egyptian subjects with MetS and 30 without with age range from 40-60 years old. All participants were free from cerebrovascular ischemic events [stroke or transient ischemic attack (TIA)]. All participants underwent complete neurological examination, assessment of the diagnostic criteria for MetS, carotid and transcranial duplex ultrasonography (U/S) and brain MRI. Results: Preclinical carotid atherosclerosis (atherosclerotic plaques with <50% stenosis) was associated with MetS (P value = 0.02) that persisted after adjustment for age and other confounders. There was no significant association between increased intima media thickness (IMT) and MetS. There was non-significant association between MetS and intracranial atherosclerotic disease (ICAD) or the degree of intracranial stenosis (ICS). Conversely, there was a highly significant association between MetS and SBI even after adjustment for age and other confounders (P value = 0.001). Conclusion: Metabolic syndrome is an important factor associated with mild to moderate atherosclerosis (<50% stenosis) and silent brain infarcts among asymptomatic individuals. Interventions to reduce MetS are important for prevention of subclinical and clinical cerebral atherosclerotic disease.

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