Stroke remains a major cause of morbidity and mortality worldwide, representing a significant public health challenge, especially in low- and middle-income countries. According to the Global Burden of Disease Study, stroke accounted for approximately 6.5 million deaths and 113 million disability-adjusted life years (DALY) globally in 2021, with over two-thirds of these events occurring in developing nations [1]. In India, the incidence of stroke ranges from 116 to 163 per 100,000 population, and it is responsible for about 3.5% of all DALYs, with ischemic stroke constituting 80-85% of all cases [2,3]. The high burden of stroke not only results in substantial healthcare costs but also has profound socioeconomic consequences, highlighting the need for effective prevention and management strategies [4]. Ischemic stroke, caused by the sudden occlusion of cerebral arteries, is often associated with modifiable risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, and alcohol use, as well as non-modifiable factors like age and sex [5,6]. Understanding the clinical profile and distribution of risk factors among ischemic stroke patients is crucial for early identification of high-risk individuals and for tailoring preventive interventions. Variations in risk factor prevalence and clinical presentation can be influenced by geographic, demographic, and sociocultural factors, necessitating region-specific studies [7].

Despite advances in acute stroke management and the growing availability of thrombolytic therapy, outcomes remain suboptimal in many resource-limited settings due to delays in presentation, limited access to specialized care, and variability in risk factor control [2,8]. Hospital-based studies are essential to identify gaps in stroke care, document prevailing risk factors, and describe clinical outcomes. This information can serve as a foundation for the development of targeted public health strategies and improvement in patient management pathways. The present study aims to evaluate the clinical characteristics, risk factors, and outcomes of patients admitted with ischemic stroke in a tertiary care hospital in Navi Mumbai.

This prospective, observational study was conducted in the Department of General Medicine at Mahatma Gandhi Mission’s Medical College, Kamothe, Navi Mumbai, over an 18-month period from July 2021 to December 2022. The study included 100 consecutive patients above 18 years of age who were admitted with a clinical diagnosis of ischemic stroke, confirmed by radiological imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Patients with intracranial hemorrhage, neurological deficits due to non-vascular causes (such as brain tumors or metastasis), or those below 18 years of age were excluded from the study. Only patients and their relatives who provided informed consent were enrolled.

For each participant, demographic information, including age, sex was recorded and detailed history was obtained to document the presence of known vascular risk factors such as hypertension, diabetes mellitus, smoking, alcohol consumption, and any prior history of cerebrovascular accident or cardiovascular disease. Physical examination included assessment of vital signs, and general systemic examination. Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale (NIHSS). Blood pressure was measured in a supine position in both arms, with two readings taken at five-minute intervals; the average was recorded. Pulse rate and oxygen saturation were also noted. All patients were followed throughout their hospital stay to record clinical features, complications, and outcomes, including discharge or death.

Data were entered in a pre-designed structured proforma and subsequently analyzed using IBM SPSS Statistics version 25. Descriptive statistics were reported as mean and standard deviation for continuous variables, and as frequencies and percentages for categorical variables. Associations between categorical variables were tested using the Chi-square test, with a p-value of less than 0.05 considered statistically significant. Data were visually presented using bar charts, pie charts, and doughnut diagrams where appropriate. Ethical clearance for the study was obtained from the Institutional Ethics Committee prior to initiation. All patient information was kept confidential, and the study imposed no additional risk or cost to participants beyond standard care.

The present study was conducted on 100 consecutive patients admitted with ischemic stroke at Mahatma Gandhi Mission’s Medical College and Hospital, Navi Mumbai. The results are presented below in terms of demographic characteristics, clinical profile, risk factors, and outcomes. The data have been systematically tabulated and analyzed to highlight the important findings and their statistical significance. The baseline demographic characteristics of the study population are summarized in Table 1. The mean age of patients admitted with ischemic stroke was 60.08 years (SD ± 12.95), with the majority falling in the 51-60 years (32.0%) and 61-70 years (28.0%) age groups. Only a small proportion of patients were under 40 years of age (6.0%). Males constituted a significant majority of the cohort, accounting for 71% of cases, while females comprised 29%.

Table 2 outlines the distribution of clinical characteristics, risk factors, and outcomes among patients with ischemic stroke. The majority of patients had left-sided lesions (53.0%), while right-sided and bilateral lesions were observed in 38.0% and 9.0% of cases, respectively. Most strokes were of moderate severity according to the NIHSS, with 89% of patients having a score between 5 and 15; severe strokes (NIHSS 21–42) were seen in only 4% of the cohort. Hypertension emerged as the most prevalent risk factor, present in 54% of patients, followed by smoking (35%), alcohol consumption (32%), and diabetes (29%). Notably, 7% of patients had no identifiable risk factors. Clinically, motor deficits were the most common presenting feature (95%), followed by speech disturbances (76%) and cranial nerve involvement (74%). Altered sensorium, seizures, and cerebellar signs were reported in 26%, 11%, and 13% of cases, respectively. Regarding outcomes, 70% of the patients were discharged, while the mortality rate in this cohort was 30%. These findings highlight the predominance of modifiable risk factors and motor deficits among ischemic stroke patients, as well as the significant burden of morbidity and mortality associated with the condition.

Table 3 presents the association of demographic, clinical, and risk factor variables with patient outcomes in ischemic stroke, analyzed using the chi-square test. Among the demographic variables, age, and gender, showed no statistically significant association with outcome, as indicated by p-values well above the conventional threshold of 0.05. In contrast, stroke severity measured by the NIHSS demonstrated a highly significant association with mortality (p = 0.002), with higher NIHSS scores corresponding to worse outcomes—patients with severe strokes (NIHSS 21–42) had a 100% mortality rate, while those with minor or moderate strokes had better discharge rates. Regarding risk factors, none—including hypertension, smoking, alcohol use, diabetes, past history of cerebrovascular accident, or having no risk factors—were significantly associated with mortality in this cohort. However, several clinical features were strongly correlated with outcomes. The presence of speech disturbances (p < 0.001), cranial nerve involvement (p < 0.001), altered sensorium (p < 0.001), and cerebellar signs (p = 0.008) were all significantly associated with higher mortality rates. In particular, patients presenting with altered sensorium had an 81% mortality rate, while those with cranial nerve involvement and speech disturbances also had notably higher proportions of death. These findings suggest that clinical features at presentation, especially those indicating severe neurological impairment, are important predictors of poor outcomes in ischemic stroke patients, whereas traditional vascular risk factors were not significantly linked to mortality in this study population.

Table 4 presents a comparison of vital signs and NIHSS scores between ischemic stroke patients who were discharged and those who died during hospitalization. The mean pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), and oxygen saturation (SpO₂) were marginally higher in the death group compared to the discharged group; however, none of these differences were statistically significant (p > 0.05), indicating that these vitals at admission were not predictive of in-hospital mortality. In contrast, the NIHSS score, which assesses stroke severity, was significantly higher in patients who died (mean 14.50 ± 4.80) compared to those who were discharged (mean 8.50 ± 1.86), with a highly significant p-value (< 0.001). This finding underscore that higher NIHSS scores, indicative of more severe strokes, are strongly associated with mortality, while admission vital parameters did not show a statistically significant impact on outcomes in this study cohort.

In summary, the results of this study highlight key clinical and demographic features among patients with ischemic stroke at our center. The majority of patients were older males, with hypertension, smoking, and diabetes emerging as the most prevalent risk factors. Most strokes were of moderate severity, with motor and speech deficits being the most common clinical presentations. Although traditional vascular risk factors were not significantly associated with mortality in this cohort, indicators of severe neurological impairment—such as high NIHSS scores, altered sensorium, cranial nerve involvement, and cerebellar signs—were strongly linked to poorer outcomes. These findings underscore the importance of comprehensive neurological assessment at presentation in predicting prognosis and guiding management in ischemic stroke patients.

The present study evaluated the clinical profile and outcomes of 100 patients with ischemic stroke, with a detailed analysis of demographic patterns, risk factors, clinical features, and prognosis. The mean age of the study population was 60.08 years, with most patients falling in the 51–70 years age group. This age profile is consistent with the rising burden of stroke in aging populations globally and in India [1,3,7]. Our observed mean age was older than that reported in some Indian studies such as Magudeshwaran et al. [9], Mugunthan et al.[10], and Yamini et al. [11], but slightly younger than in the study by Abdul Gafoor et al. [12]. Males were predominantly affected (71%), with a male-to-female ratio of 2.44:1, aligning with previous Indian reports [9–12]. The greater male prevalence, especially at younger ages, may reflect earlier exposure to risk factors among men and protective effects of estrogen in women before menopause [5].

Hypertension was the most common modifiable risk factor in this cohort (54%), comparable to prior studies from India and globally [6,13]. The prevalence of hypertension, along with other vascular risk factors, underscores the major contribution of modifiable factors to stroke incidence, as highlighted in the INTERSTROKE and GBD studies [9,10]. Smoking (35%) and alcohol consumption (32%) were also prevalent, in line with both national and international findings [10,14,15]. Diabetes mellitus was seen in 29% of patients, a higher proportion than reported in Western studies, reflecting the growing epidemic of diabetes in South Asia [14,16]. Previous history of stroke was identified in 12% of patients [17]. Clinically, motor weakness was the most common presenting symptom (95%), similar to the findings in other Indian and Western cohorts [14]. Speech disturbance (76%) and cranial nerve involvement (74%) were also frequent. Other presenting features included altered sensorium (26%), seizures (11%), and cerebellar signs (13%). These findings are consistent with reports highlighting the heterogeneous and multifocal nature of neurological deficits in ischemic stroke [5,8]. The mean NIHSS score at presentation was 10.3, suggesting that most strokes were of moderate severity, and comparable to recent Indian data [11].

Outcome analysis revealed that 70% of patients were discharged, while 30% died during hospitalization—a finding that reflects the significant morbidity and mortality associated with acute stroke in resource-limited settings [3]. Statistical analysis demonstrated that traditional vascular risk factors (hypertension, diabetes, smoking, alcohol, past CVA) were not significantly associated with in-hospital mortality. In contrast, clinical features at presentation—particularly stroke severity (NIHSS), speech disturbance, cranial nerve involvement, altered sensorium, and cerebellar signs—showed significant associations with poor outcomes. This highlights the importance of comprehensive neurological assessment at presentation in predicting prognosis, as also emphasized in global stroke care guidelines [4,5]. Overall, this study underscores the persistent burden of modifiable risk factors among ischemic stroke patients in India, paralleling global trends [1,3,6]. The findings reinforce the need for effective risk factor modification and timely neurological evaluation to improve stroke outcomes, especially in low- and middle-income settings [2,4,8].

In conclusion, this study highlights the predominance of modifiable risk factors such as hypertension, smoking, and diabetes among ischemic stroke patients. While traditional risk factors were not significantly associated with in-hospital mortality, clinical features indicating neurological severity at presentation were strong predictors of poor outcomes. Early identification and targeted management of high-risk patients remain crucial for improving stroke prognosis.

Conflict of Interest: The authors declare that there is no conflict of interest regarding the publication of this study.

Funding: This research received no external funding.

1. Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:439–58.
2. Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J. Stroke 2013;15:128–34.
3. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ. Res. 2017;120:439–48.
4. Owolabi MO, Thrift AG, Martins S, Johnson W, Pandian J, Abd-Allah F, et al. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys. Int. J. Stroke Off. J. Int. Stroke Soc. 2021;16:889–901.
5. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018;137:e67–492.
6. O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet Lond. Engl. 2016;388:761–75.
7. Kamalakannan S, Gudlavalleti ASV, Gudlavalleti VSM, Goenka S, Kuper H. Incidence & prevalence of stroke in India: A systematic review. Indian J. Med. Res. 2017;146:175–85.
8. Thomas SV. Acute stroke care in India. Ann. Indian Acad. Neurol. 2008;11:S1.
9. Magudeeswaran R. Study of clinical profile and risk factors in acute ischemic stroke in Government Vellore Medical College Hospital, Vellore [Internet]. 2013;Available from: http://repository-tnmgrmu.ac.in/3604/
10. Mugunthan K. Clinical profile, neuroimaging evaluation and treatment outcome of acute ischemic stroke patients [Internet]. 2015;Available from: http://repository-tnmgrmu.ac.in/2774/
11. Yamini K. A study of clinical profile of patients undergoing stroke thrombolysis in a tertiary care hospital [Internet]. 2018;Available from: http://repository-tnmgrmu.ac.in/10473/
12. Gafoor ALA. Study on risk factors, clinico-radiological profile and the outcome in patients with acute cerebrovascular disease [Internet]. 2012;Available from: http://repository-tnmgrmu.ac.in/4593/
13. Mugunthan K. Clinical profile, neuroimaging evaluation and treatment outcome of acute ischemic stroke patients [Internet]. 2015;Available from: http://repository-tnmgrmu.ac.in/2774/
14. Martí-Vilalta JL, Arboix A. The Barcelona Stroke Registry. Eur. Neurol. 1999;41:135–42.
15. Kiely DK, Wolf PA, Cupples LA, Beiser AS, Myers RH. Familial aggregation of stroke. The Framingham Study. Stroke 1993;24:1366–71.
16. Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke 1988;19:1083–92.
17. Kuriakose G. A prospective study of clinical profile of stroke in a tertiary care hospital [Internet]. 2013;Available from: http://repository-tnmgrmu.ac.in/4999/