Clinical profile and serum homocysteine level in young patients with stroke: a prospective, observational study

Manoharan S., Sathyasagar K., Natesh Prabhu M.


Background: According to the WHO, stroke is the second most important cause of death in elderly people with age >60 years and fifth leading cause in the age group of 15 to 59 years. Hyperhomocysteinemia has been linked to increased incidence of ischemic strokes. Thus, the aim of the present study was to assess serum homocysteine levels as an individual risk factor of stroke in young patients.

Methods: This was a prospective, cross-sectional, single center study performed in 50 patients admitted in the Department of Medicine, Thanjavur Medical College and Hospital, Thanjavur, over a period of 7 months (i.e., from December 2013 to June 2014). Young patients, aged 1545 years, and diagnosed with stroke were included in the study. Serum homocysteine was measured by fluorescein polarization immunoassay (FPIA). Significant difference between the patients with normal and elevated mean serum homocysteine levels was identified by using unpaired t-test. P value ≤0.05 was considered as statistically significant.

Results: Majority of the stroke patients were male (78%). Similarly, male patients dominated the total number of patients with elevated serum homocysteine levels (75%). Thirty-two (64%) patients had an elevated serum homocysteine level. There was a significant difference between the patients with increased homocysteine levels as compared to patients with normal homocysteine levels (p value <0.05). Out of 32 patients with hyperhomocysteinemia, 27 (84.38%) patients had ischemic stroke, 4 (12.50%) had cortical vein thrombosis and 1 (3.12%) had hemorrhagic stroke.

Conclusions: Findings of the present study confirm that hyperhomocysteinemia is associated with an increased incidence of stroke in young patients. As healthcare providers, we must stress on prevention of stroke, especially by identifying treatable risk factors.


Cortical vein thrombosis, Fluorescein polarization immunoassay, Hyperhomocysteinemia, Ischemic stroke, Serum homocysteine, Young stroke

Full Text:



Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Health Organization. 2016;94(9):634.

Kamalakannan S, Gudlavalleti AS, Gudlavalleti VS, Goenka S, Kuper H. Incidence & prevalence of stroke in India: a systematic review. Indian J Med Res. 2017;146(2):175-85.

Murmu M, Karun MKP, Dash S, Singh LK, Kar A, Mishra P. Study of serum homocysteine level in cases of non-diabetic ischemic stroke. Int J Res Med Sci. 2018;6(5):1611-6.

Modi M, Prabhakar S, Majumdar S, Khullar M, Lal V, Das CP. Hyperhomocysteinemia as a risk factor for ischemic stroke: an Indian scenario. Neurol India. 2005;53(3):297-301.

Prasad K, Singhal KK. Stroke in young: An Indian perspective. Neurol India. 2010;58(3):343-50.

Yashaswini LS, Patil MB. Stroke in a Young Adult Secondary to Vitamin B12 Deficiency induced Hyperhomocysteinemia. J Med Sci. 2015;1(1):10-3.

Chrysant SG, Chrysant GS. The current status of homocysteine as a risk factor for cardiovascular disease: a mini review. Expert Rev Cardiovascular Therapy. 2018;16(8):559-65.

Zongte Z, Shaini L, Debbarma A, Singh TB, Devi SB, Singh WG. Serum homocysteine levels in cerebrovascular accidents. Indian J Clin Biochem. 2008;23(2):154-7.

Manolescu BN, Oprea E, Farcasanu IC, Berteanu M, Cercasov C. Homocysteine and vitamin therapy in stroke pre vention and treatment: a review. Acta Biochimica Polonica. 2010;57(4): 467-7.

Gajbhare PT, Juwale NI. The study of plasma homocysteine level as a risk factor for ischemic strokes in young patients. Int J Adv Med. 2017;4(4):1019-25.

Spence JD. Homocysteine lowering for stroke prevention: unravelling the complexity of the evidence. Int J Stroke. 2016;11(7):744-7.

Mishra T, Ishwar A, Pandey P, Singh A, Chandrakar MP, Pharmani S. A study of clinical profile and risk factors in Ischemic stroke with special reference to serum homocysteine and lipid profile: a cross sectional observation study. Int J Adv Med. 2016;3(4):888-92.

Desai D, Jotkar SK, Dambal A, Kalsad ST, Nimbal NV, Desai PD, et al. Study of hyperhomocysteinaemia as a risk factor for atherothrombotic cerebrovascular accident in young adults. J Evol Med Den Sci. 2015;4(51):8832-9.

Ashjazadeh N, Fathi M, Shariat A. Evaluation of homocysteine level as a risk factor among patients with ischemic stroke and its subtypes. Iran J Med Sci. 2013;38(3):233-9

Kang JY, Park IK, Lee JY, Sung SH, Chang YK, Park YK, et al. Use of serum homocysteine to predict cardiovascular disease in Korean men with or without metabolic syndrome. J Korean Med Sci. 2012;27(5):500-5.

Bogdan NM, Eliza O, Ileana CF. Homocysteine and vitamin therapy in stroke prevention and treatment: a review. Acta Biochim Pol. 2010;57(4):467-77.

Datta S, Pal SK, Mazumdar H, Bhandari B, Bhattacherjee S, Pandit S. Homocysteine and cerebrovascular accidents. J Indian Med Assoc. 2009;107(6):345-6.

Boysen G, Brander T, Christensen H, Gideon R, Truelsen T. Homocysteine and risk of recurrent stroke. Stroke. 2003;34(5):1258-61.

Narang APS, Verma I, Kaur S, Narang A, Gupta S, Avasthi G. Homocysteine - risk factor for ischemic stroke?. Indian J Physiol Pharmacol. 2009;53(1):34-53.

Raheem SA. Serum Homocysteine Levels in Cerebrovascular Accidents. J Evol Med Dent Sci. 2014;3(1):192-9.

Brattstrom LE, Hardebo JE, Hultberg BL. Moderate homocysteinemia: a possible risk factor for arteriosclerotic cerebrovascular disease. Stroke. 1984;15(6):1012-6.

Alfthan G, Pekkanen J, Jauhiainen M, Pitkäniemi J, Karvonen M, Tuomilehto J, et al. Relation of serum homocysteine and lipoprotein (a) concentrations to atherosclerotic disease in a prospective Finnish population based study. Atheroscler. 1994;106(1):9-19.

Mousavi SA, Ghasemi M, Hoseini T. Association between plasma homocysteine concentrations and extracranial carotid stenosis. Ann Saudi Med. 2006;26(2):120-2.