Epidemiological and clinical characteristics of acute ischemic stroke patients in a war zone

Background: Acute ischemic stroke is a leading cause of mortality and long-term disability worldwide. In conflict-affected regions, timely diagnosis and guideline-based management are often compromised due to damaged infrastructure and limited healthcare resources. This study aimed to evaluate the demographic, clinical, laboratory, and radiological characteristics of patients with acute ischemic stroke admitted to a humanitarian hospital in northern Syria and to identify factors associated with adverse in-hospital outcomes. Methods: This retrospective observational study included adult patients (≥18 years) diagnosed with acute ischemic stroke and admitted to the emergency department of Çobanbey Humanitarian and Technical Hospital between January 2023 and December 2024. Diagnosis was confirmed by clinical evaluation and brain computed tomography. Demographic data, comorbidities, presenting symptoms, laboratory and imaging findings, and in-hospital outcomes were recorded. The primary outcome was a composite of in-hospital mortality or intensive care unit (ICU) admission. Logistic regression analyses were performed. Results: A total of 136 patients were included, of whom 62 were female, with a mean age of 67 ± 14.6 years. Smoking prevalence was high (89%), while hypertension (37.5%) and diabetes mellitus (22.1%) were the most common comorbidities. Hemiparesis (62%), impaired consciousness (61%), and dysarthria (38%) were the most frequent presenting symptoms. Only 30.1% of patients presented within the 4.5-hour window for intravenous thrombolysis. Middle cerebral artery infarction was the most common radiological finding (43.4%). In-hospital mortality was 11.0%, and 44.1% of patients required ICU admission. In multivariate analysis, low serum thyroxine (T4) levels were independently associated with poor outcomes. Conclusions: Acute ischemic stroke management in conflict settings is limited by delayed presentation, restricted access to reperfusion therapies, and infrastructural constraints. Simple clinical and laboratory parameters may assist early risk stratification in resource-limited humanitarian hospitals.

Acute ischemic stroke; Cerebrovascular infarction; Conflict; Humanitarian hospital

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