Stroke characterizes an imperative public health problem. It is the third most prevalent reason of death after heart disease and cancer, also it considered as a foremost source of long-term disability .
Stroke survivors remain to be at advanced risk of disability and death, and it is of great clinical importance to expect outcome in acute stroke. Plentiful clinical variables (e.g., advanced age and symptom severity) have been recognized as probable predictors of outcome. Furthermore, countless biomarkers have been proposed to predict ischemic stroke outcome [16, 17].
Malondialdehyde (MDA) is an end-product of the radical-initiated oxidative breakdown of poly-unsaturated fatty acids and, hence, it is a commonly measured biomarker of oxidative stress .
The study was prospective cohort study included 42 patients (20 males and 22 females) their ages ranged from 53 to 72 years with a mean age (62.95 ± 4.21 (SD) with the first ever acute ischemic stroke within 7 days of symptoms onset. The patients were sequentially recruited from Neurology Critical Care Unit and Neurology Stroke Unit, Neurology Department, Zagazig University Hospitals.
The results of our study were 66.7% of patients had moderate to severe NIHSS score (16-20) compared to 33.3% of patients had moderate NIHSS score (5-15). This is in agreement with the results of Mendioroz et al.  who stated that 59.9% of patients (on admission) showed NIHSS score (16-20). Also, Mansour et al.  recorded in a cohort study that their patients NIHSS median value at 24 h was 22 (16–30) and at 72 h was 20 (11–30), otherwise Soliman et al.  reported that 61.7% of their patients show NIHSS moderate score (5–15), and moderate to severe in 11.4.
In our study, 42.9% of the studied ischemic stroke patients had MDA level more than 2.65 nmol/L, while 57.1% of patients had MDA level less than 2.65 nmol/L. Similar percentages of elevation of MDA level in acute ischemic stroke patients (21-52%) were recorded by Yaseen et al. , Lorente et al. , and Silina et al. .
In this study, the unfavorable functional outcome (mRS 2-5) found in 50% of cases, 38.1% had favorable outcome (mRS < 2), and 11.9 % of patients were dead (mRS = 6).
The outcome of our patients as regards the disability is quietly similar to the previous studies like that of Mendioroz et al.  who found that 55.3% of patients displayed a worse prognosis (mRS 2-5) at 3 months follow-up. In addition, Mansour et al.  reported mortality (19.7%) and unfavorable outcome (mRS 2–5) at 3 months follow-up (56.7%) and Soliman et al.  found that 56.3% of their patients showed unfavorable functional outcome mRS (2-5).
In the current study, concerning relationship between MDA and National Institutes of Health Stroke Scale (NIHSS), we found no significant relation between level of MDA and stroke severity when assessed by NIHSS score on admission. Our result goes in hand with Shoeibi et al.  who reported that there was a non-significant relation between NIHSS and MDA (p = 0.791). Also, Ferhat et al.  who reported that there were no significant relations between the NIHSS value and oxidative stress biomarkers. Nevertheless, this was in disagreement with Yaseen et al.  who stated that the MDA levels on the day of admission and after 7 days correlate positively with the stroke severity as measured by NIHSS score.
Demirkaya et al.  reported significant relations between MDA levels and stroke severity on NIHSS. They rational this significance as follow: there is huge generation of free radicals (MDA) through ischemia in the penumbral tissue which has a least oxygen supply. The degree of damage induced by free radical be contingent with the antioxidant defense mechanism. In severe stroke, the availability of antioxidants cannot cope up with the abrupt upsurge in free radicals due to greater tissue damage amount. The antioxidant enzymes are inducible enzymes hence their transcription and synthesis take time. Consequently, in the initial phase, there is an increase in lipid peroxidation due to failure of defense mechanisms that reflects the volume of tissue damage and henceforth the stroke severity.
We could not detect any significant relation between levels of MDA and NIHSS; however, these MDA levels were measured only at the initial presentation, and follow-up measurements could help to illuminate MDA changes and ischemic stroke severity.
As regarding the relationship between the stroke outcome (functional disability evaluated by mRS, there was highly statistically significant difference between patients with unfavorable and favorable outcomes of mRS and mean values of MDA, and we found statistically significant positive correlation between mRS and MDA level.
The existing study revealed a statistically high significant difference between stroke patients with 3 months favorable functional outcome (mRS < 2) and those with unfavorable outcome (mRS 2-5) as regarding the mean values of MDA. Similarly, we found high significant positive correlation between mRS and MDA levels. Our results are quietly similar to a previous study of Tsai et al.  who reported a significant positive correlation between MDA levels and acute ischemic stroke outcome at 3 months based on mRS.
Also, Cherubini et al.  found a significant positive correlation between the MDA levels on admission in stroke patients’ functional outcome by mRS after 1 week. In addition, Yaseen et al.  reported that MDA levels on admission and after 7 days prophesied the patients’ functional disability on the 7th day and subsequently 6 months by mRS.
Lipid peroxidation (LPO) brought by asynuclein misfolding might play a vital role in the cellular mechanism of neuronal cell injury. In addition, LPO products could act as possible triggers of the p53 signaling pathway and cause membrane organization disturbance and loss of mitochondrial DNA functionally .
The restriction of this study, that serum MDA levels were only estimated for all patients within the first 24 h after admission. It may be indispensable to conduct a further longitudinal study determining serum MDA levels at multiple time points after stroke and appraising the prognostic value of MDA at later times.
The inconsistency of results is credited to a deficient sample size, study differences in population- and patient-level characteristics (i.e., socio-demographics and clinical factors), methodology).
Our findings should be considered preliminary, and additional clinical trials with MDA should be directed to explain whether modulation of oxidative stress in patients with stroke may support therapeutic indication in order to influence the ischemic stroke severity and outcome (functional). Hence, future studies will be compulsory to explore whether MDA imitates the severity and functional outcome after stroke in a greater sample and in groups with more consistency.