<![CDATA[Ischemic stroke results from reduced cerebral blood flow due to vascular occlusion, while Acute Stroke in Evolution (ASE) is characterized by progressive neurological deterioration during the acute phase. Cytoflavin has been proposed as an adjuvant neuroprotective therapy because of its potential to support cellular metabolism and tolerance to hypoxia; however, clinical evidence regarding its role in ASE remains limited, particularly in patients with multiple vascular risk factors. To document serial changes in neurological deficit, assessed using the National Institutes of Health Stroke Scale (NIHSS), and the safety of Cytoflavin as an adjuvant therapy in a single case of ASE with multiple risk factors. This was a prospective single-case report of a 38-year-old man with lacunar ischemic stroke managed at Dr. Chasbullah Abdul Majid Regional Hospital, Bekasi City. Clinical progression was evaluated through serial neurological examinations, NIHSS assessments, and head computed tomography (CT). The patient presented with sudden right-sided weakness, dysarthria, and facial deviation. His vascular risk factors included uncontrolled diabetes mellitus, hypertension, obesity, dyslipidemia, and smoking. The initial NIHSS score was 5, and head CT demonstrated a left basal ganglia lacunar infarction. On day four, neurological deficits worsened, with right-sided motor strength decreasing to 2/5 and the NIHSS score increasing to 12, consistent with ASE. Intravenous Cytoflavin 500 mg in 100 mL 0.9% NaCl three times daily was administered for 10 days. Neurological improvement began on day six. By day ten, motor strength improved to 5−, the patient was able to ambulate with mild hemiparesis, and the NIHSS score decreased to 4. The neurological improvement was temporally associated with the administration of Cytoflavin and comprehensive supportive management. No significant safety concerns were observed during treatment. In this single uncontrolled case of ASE, administration of Cytoflavin as an adjuvant therapy was temporally associated with improvement in neurological deficits, reflected by a reduction in NIHSS from 12 to 4 over 10 days. However, no causal inference can be drawn from a single uncontrolled case. These findings highlight the need for randomized controlled trials to determine the efficacy and safety of Cytoflavin as an adjuvant neuroprotective therapy in patients with ASE. Keywords: Cytoflavin, Stroke Iskemik, NIHSS, Infark Lacunar]]>
