الفهرس 
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Abstract
Summary & Conclusion
Stroke is a disease of very high burden all over the world. Stroke was considered to be the second most common cause of death after cardiovascular ischemia and the third most common cause of disability, according to the Global Burden of Disease (GBD).
Approximately 120 million people are chronically infected with the hepatitis C virus (HCV), and Egypt has the highest HCV infection prevalence (20 to 30%), worldwide. In parallel, the burden of chronic HCV-related liver disease in Egypt continues to rise.
HCV infection is associated with an increased risk of ischemic cerebral stroke. HCV stroked patients are younger with a lower burden of classical risk factors and higher levels of systemic inflammation.
Interferon‐based therapy may reduce the long‐term risk of stroke in patients with chronic HCV infection.
The aim of this work was to study the possible relation between HCV infection and ischemic stroke incidence and severity at presentation in a sample of stroke patients in Beni-Suef governorate, north Upper Egypt.
The study is a case control study included 120 individuals attended to the outpatient clinic and emergency room in in Beni-Suef University Hospital and conducted in department of neu¬rology, Beni-Suef University during the period between November 2019 and August 2020.
All included patients were subjected to the following :
• Detailed history taking with special focusing on hypertension , diabetes , smoking , alcohol abuse , family history [paternal & maternal] of stroke and previous history of stroke or transient ischemic attacks.
Body mass index ( BMI) calculation , blood pressure , thorough general examination ,complete cardiological examination , thorough neurological examination , NIHSS at presentation , modified Rankin Scale (mRS) after 3 months.
• Brain computed tomography (CT) , electrocardiography ( ECG ) , Echocardiography , Carotid duplex.
• Laboratory investigations including: Complete blood count, liver functions, kidney functions , electrolytes , fasting blood sugar, 2 hours post prandial , glycated hemoglobin (HbA1C), total cholesterol, low density cholesterol and high density cholesterol ,Hepatitis marker (HCV Ab), HCV RNA detected by PCR.
• Young patients (15-45 years old ) with no obvious risk factor were subjected to immunological tests( antinucuar antibody, anti-neutrophil cytoplasmic antibody, anti double strand DNA and rheumatoid factor) , anticardiolipin, lupus anticoagulant , protein C,S , antithrombin III , detection of Factor V Leiden mutation .
The results of our study were summarized in the following:
• Prevalence of HCV was higher in patients with stroke than that observed in control (21.7% vs. 8.3%, p = 0.041).
• Majority of negative HCV patients (86.7%) had normal carotid artery comparing to (30.8%) at positive HCV patients while (2.2%) negative HCV patients had stenosis≥50 comparing to (23%) at positive HCV patients (p = 0.0001).
• The NIHSS score mean values in the positive HCV infected patients (14.77±7.407) was higher than those who are negative HCV infected (10.47±6.049) , p value =0.048).
• The NIHSS score in the positive without treatment HCV infected patients was higher than those who were positive with treatment HCV infected (p=0.005).
• The mRS score means in the positive HCV infected patients was higher (3.46) when compared to corresponding values in negative patients (p value =0.013).
• The mRS score means in the positive without treatment HCV infected patients was higher (4.57) when compared to corresponding values at positive with treatment with statistically significant difference (p=0.05).
• There was a positive correlation between PCR and stroke severity according to NIHSS score and the p value =0.004).
• There was a positive correlation between PCR and stroke disability according to MRS score and the p value =0.002).
Finally we concluded that
1. HCV infection is associated with an increased risk of ischemic cerebral stroke.
2. There is a highly significant positive correlation between stroke severity and HCV infection.
3. Treatment of chronic hepatitis C virus with the antiviral drugs decrease the risk of stroke and its poor functional outcome.