الفهرس 
Acknowledgment
Epidemiology of ICA MVOnly 14 pages are availabe for public view
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Abstract
Although abnormalities in course and geometry (tortuosity, kinking, and coiling) of the internal carotid arteries (ICA) are commonly identified, their etiology and relationship with stroke and stroke risk factors remain unclear.
The present study was designed to estimate the relative frequency of MV in ICA among ischemic stroke patients using extracranial duplex ultrasound technique, and to assess the relationship between MV in ICA and burden of cerebrovascular diseases regarding to neurological deficit and cognitive impairment of ischemic stroke, and its predictors.
One hundred and two (out of recruited 550) patients diagnosed as ischemic stroke patients, who admitted to the Neurology inpatient wards in Assuit University hospital, from November 1, 2017 to April 30, 2019,were met the inclusion and exclusion criteria, and included in the present study.
These patients were clinically assessed and subjected to neurovascular assessment tools in Neuropsychiatry and vascular surgery departments using clinical rating scales and extracranial duplex ultrasound technique ultrasound examination technique and scanning .Their mean age was 65.7 ±13.5years old, and female to male was 89/23.
Each patient was subjected to the following:
1-Detailed History case taking,
2- Systemic and neurological examination
3-Routine investigations for detection of risk factors of ischemic stroke; ECG, chemistry, serum blood sugar, blood picture and coagulation profile
4-C.T. brain.
5- Clinical rating scales of neurological deficit of stroke and functional state (i.e. NIHSS, BI, and MRS).
6- Neuropsychological assessment of cognitive functions in suitable patients for assessment, using MMSE, MoCA tests. Only 40 patients could be assessed for cognitive function (the remaining patients were either confused, or aphasic or not cooperative in assessment.
7- Duplex scanning of extra cranial part of internal carotid artery
The results of the present study were revealing that;
• Internal Carotid Artery morphological variations was found in 11 patients, proximal to bifurcation of ICA, giving the relative frequency of 10.8% and with predominant female sex distribution in 55 % of positive cases. These MV was recorded unilateral in majority (90.9) of cases and predominant in left ICA in 72.7% while, one case only showed MV of ICA bilaterally (9.1%).
• Pattern of Internal Carotid Artery morphological variations in positive cases with Internal Carotid Artery morphological variations, was tortuous in 8 cases (72.7%) and kinking in 4 cases (36.4) as one case showed Kinging of ICA bilaterally.
• The highest peak of age and sex specific rate of MV was recorded among age group 60-69years either among both sexes or women with p=0.170, while the highest specific rate among men was among age group 70-79yrs .The sex specific rate was higher among men than women in all age groups except among age group 60-69 years showed higher specific rate among women than men patients 22.2 % vs. 16.7% respectively, p>0.05.
Neuroimaging of the brain was done for all patients with cerebrovascular disease including patients with Internal Carotid Artery morphological variations showing that;
• These patients showed multiple lacunar infarctions in 54.5%, massive infarction in 27.3% and White matter ischemia in 18.2%.
• Six patients of them showed multiple lacunar infarctions in neuroimaging findings of the brain, one of them presented with TIA for 2 hours in the form of dysarthria.
• Three patients showed massive infarction in Neuroimaging findings of the brain, two of them showed complete middle cerebral occlusion and the remaining one showed internal carotid artery occlusion.
All sample study including positive cases with MV in ICA course was subjected to assessment of Neurological deficit of stroke and disability of stroke using clinical rating scales; NIH Stroke scale (NIHSS), Barthel index (BI) and Modified Rankin scale (MRS).
• The mean score of NIHSS among positive cases with MV in ICA course, was 15.20 ±4.442 and ranged from 2-22.and the majority of these cases (90%) had moderate or severe neurological deficit based on NIHSS score.
• Only forty cases of sample study were subjected to assessment of cognitive functions using MMSE and MoCA scales, seven of them showed MV in ICA course, and the remaining cases couldn’t be assessed cognitive functions because of severe neurological deficit presenting with disturbed conscious level, or aphasia or mental changes or uncooperative patients or patients with marked diminution of vision or hearing.These seven positive cases with MV in ICA course showed cognitive impairment ranged from mild cognitive impairment to mild dementia based on MMSE according to educational level.
On comparing between scores of clinical rating scales of neurological deficit of stroke and disabilities among patients with vs without MV ICA;
• We found no significant difference between scores of clinical rating scales of neurological deficit and functional disability of ischemic stroke in both groups either in NIHSS( 15.2±4.6), BI(58.7±7.9 ), and MRS scores(4.0 ±1 ), p>0.05.
• Severity of neurological deficit of stroke based on NIHSS score was ranged from moderate to severe; 90.9% vs 96.7% among both groups.
• We found that these patients with MV in ICA course had significant lower scores in MMSE and MoCA (20.4±2.1;17.0±2.7% respectively ), compared to that of patients without MV IN ICA course (22.8±2.3;19.8±2.2) respectively ,p<0.05.
• On assessment the severity of cognitive impairment in ischemic stroke patients of both groups based on MMSE score of each group, we found that patients with MV in ICA course had slightly higher frequency of mild dementia compared to that of patients without MV in ICA course; 57.1% vs 48.5%, and the reverse was observed in mild cognitive impairment; 42.9% vs. 51.5%, p>0.05.
• The significant predictor for MV in ICA course among ischemic stroke patients was age, p=0.045, Beta=.-0.387, 95%CI [-.017-0.0].