Hyperhomocysteinaemia And Vitamin B12 Deficiency In Ischaemic Strokes In India

Hyperhomocysteinemia is a recognised risk factor for stroke and ischemic heart disease (HID). Vit B12 Folate and pyridoxine deficiency are important causes of raised serum homocysteine. As a vegetarian diet is very poor in Vit B12 we sought to study the incidence of hyperhomocysteinaemia in our stroke populating and to measure Vit B12 and folate in these cases. Consecutive cases of ischaemic stroke, either arterial or venous, admitted over a period of 2 1/2 years were studied. Embolic strokes and those on vitamin supplements were excluded. cases were divided into vegetarian (including those taking milk and / Or eggs), those who took non-vegetarian 4 or less times a month, and frequent non-vegetarians taking 5 or more times a month. Serum total homocysteine, serum B12 and folate levels were studied along with all other routine parameters. For comparison we examined 101 controls without HID, stroke, peripheral vascular disease, rental failure or recent vitamin intake. With the international norm for homocysteine given as 5-15 umol/litre (1)we called serum homocysteine 16 umol/litre or more as raised. There were 147 cases of ischcmic stroke :119 arterial and 28 venous infarcts. In the arterial strokes 99 of 119 cases (83.19%) had raised serum Homocysteine including 25 of 27 (92.5%) of those with arterial stroke before age 45. Of 28 cases with venous infarct 21 (75%) had raised homocysteine (HCY). Hyperhomocysteinemia was the commonest risk factor for stroke in our populations. Out of the total 147 cases the exact dietary intake was not known for ten cases., 58 were vegetarians, 54 were occasional non vegetarians (NV) and 25 were frequent NV. In the 58 vegetarians, 55 had serum HCY> 16 umol/1 (94.8%) and of those vegetarians with HCY> 16, serum B12 16umo/1 (85.2%) Of those with HCY >16, serum B12 level of