Increased Risk of Ischemic Stroke among Patients with Multiple Sclerosis: A Systematic Review

Multiple sclerosis is known to be an autoimmune disease that reduces the life expectancy of patients with comorbidities such as ischemic stroke. The aim of this systematic review is to estimate the increased risk of ischemic stroke in patients with multiple sclerosis. Literature review was conducted using bibliographic databases, Pubmed, Google Scholar, SID, Iranmedex and ISC (from April 2014 to March2019) on studies related to increased risk of ischemic stroke in patients with multiple sclerosis. One reviewer abstracted data using a standardized data collection form, while the second reviewer verified the abstraction. From 620 articles that were reviewed by title, 29 wereextracted and after reading the abstractions, five studies were included in the study. Five cohort studies with a total of approximately 35 thousand MS patients and a minimum of three years follow-up were included. Only one study was particularly focused on the riskof ischemic stroke and others studied cardiovascular diseases and comorbidities in MS patients. A New York City based study investigated vascular disease among hospitalized multiple sclerosis patients. They reported that MS patients were less likely to be hospitalized for ischemic heart disease but more likely to be hospitalized for ischemic stroke. Overall, MS patients had higher incidence of ischemic stroke and hospitalization compared to the control groups. Conclusions :This literature review concludes that MS patients are at a higher risk of ischemic stroke. Nonetheless, there is still insufficient understanding of the nature of these findings. Therefore, we suggest in-detailed studies designed to understand the high prevalence of ischemic stroke amongst MS patients.