A retrospective study of risk factors and clinical profile of acute stroke

 

Sunil Tukaram Kotkunde¹, Nitin Dnyandev Kesarkar^2*

 

Abstract              Background: Stroke is a devastating and disabling cerebrovascular disease with significant amount of residual deficit leading on to economic loss. It has been defined as a rapidly developing signs of focal (or global) disturbance of cerebral function with symptoms lasting for ≥24 hours, or leading to death with no apparent cause other than vascular origin. Materials and methods: This is a retrospective study of 238 cases managed for stroke in the medical ward of B.K.L. Walavalkar Rural Medical College from January 2018 to December 2018. The case notes of the pts were retrieved from the medical department of the hospital and relevant data extracted and analyzed. We have only CT scan machine in house, for MRI we have to send pts to higher centers.   Results: The cerebrovascular strokes are more common in males (59.7%) than females (40.3%). Most common age group was 61-70 years (32.8%). Most common clinical feature was hemiplegia (72.6%). Most common risk factor was Hypertension (34%) followed by past h/o cerebrovascular stroke (15%), smoking (14%), dyslipidemia (13%). Most common type of stroke was ischemic (74.6%) and hemorrhagic was 2nd (22.9%). In ischemic stroke most common involved areas were parietal (33.7%), frontal (16.7%). In hemorrhagic stroke most common site was thalamus (24.7%) followed by ventricular (17.5%). Conclusion: The cerebrovascular stroke cases were having male predominance with Hypertension was the most common risk factor and most common type of stroke was ischemic.

Key Words: Cerebrovascular stroke, Ischemic stroke, Hemorrhagic stroke

 

INTRODUCTION

Stroke is a devastating and disabling cerebrovascular disease with significant amount of residual deficit leading on to economic loss.¹ It has been defined as a rapidly developing signs of focal (or global) disturbance of cerebral function with symptoms lasting for ≥24 hours, or leading to death with no apparent cause other than vascular origin. It is a collection of clinical syndromes resulting from cerebral ischemia to intracranial hemorrhage. In the west, it is the 3rd most common cause of morbidity and mortality.² Some of the recent studies have elucidated the stroke pattern to considerable extent in our country with a prevalence rate o471.58/100000 population.3 Recent study identified that 7% of medical and 45% of neurological admissions were due to stroke with a fatality rate of 9% at hospital discharge and 20% at 28 days.4 Hypertension, alcoholism, smoking and dyslipidemia are commonest cause of stroke among the elderly,³ and smoking, alcoholism, increased BMI, diabetes and hypertension are significantly associated with strokes among young people. Ischemic strokes account for 50%-85% of all strokes worldwide.7 Hemorrhagic strokes are due to subarachnoid hemorrhage or intracerebral hemorrhage, they account for 1%-7% and 7%-27% respectively of all strokes worldwide.⁴ The Indian national commission on macro economics and health estimated that the number of strokes will increase from 1081480 in 2000 to 1667372 in 2015.⁵ The global burden of disease Study projects that total deaths from stroke in India will surpass established market economies by year 2020.⁶ Hence this study was undertaken in our set up to study risk factors and clinical profile of acute stroke.

 

MATERIALS AND METHODS

This is a retrospective study of 238 cases managed for stroke in the medical ward of B.K.L. WALAVALKAR RURAL MEDICAL COLLEGE from January, 2018 to December 2018. The case notes of the pts were retrieved from the medical department of the hospital and relevant data extracted and analyzed. We have only CT scan machine in house, for MRI we have to send pts to higher centers.

Inclusion criteria

• All pts above age 18 yrs and having clinical and CT confirmed diagnosis of stoke.

Exclusion criteria

• Patients below 18.
• Stroke due to trauma.
• Pts’ medical records which were not showing CT confirmed diagnosis.
• Medical records in which pt sent for MRI brain with inconclusive CT scan findings.

The data obtained were analyzed using SPSS version 21.0 software. Results were expressed in frequencies and percentages.

RESULTS

238 cases of stroke case records managed in medical ward of B.K.L. Walavalkar Rural Medical College during a period of 1st January 2012 to 31st December 2013 were studied and evaluated for clinical profile and frequency of risk factors.

Incidence of age

The age range was from 26 years to 100 years with mean age of 61 years. In this study youngest pt was 26 years and oldest was 100 years old. The incidence of stroke is maximum in the age group of 61-70 years which comprises of 32.8% of total pts, as shown in Table 1. Young stroke (age ≤45 years) comprised of 15% of all pts.

 

Table 1: Frequency and percentage of cases according to age groups

 Sex distribution of stoke pts

Out of 238 pts, 142 were males and 96 were females as shown in Table 2.  The male to female ratio was 1.4:1. From above observation it can be concluded that incidence  of stroke is more common in male sex.

 

Table 2: Sex wise distribution of stoke cases

Clinical presentation of stroke pts

In our study as shown in Table 3, most common clinical presentation was hemiplegia which was 48% followed by speech involvement (25.1%), altered sensorium (13.1%), convulsions (5%), instability of gait (3.9%), vomiting (3.1%) and headache (3.1%).

 

Table 3: Frequency and percentage of clinical features of stroke patients

 

Prevalence of risk factors in stroke pts

In our study most common risk factor was hypertension with 34.1% incidence. it followed by previous H/o cerebrovascular accident 15%, smoking 14.2%, dyslipidemia 13.4%, diabetes mellitus 9.3%, alcohol 7.9%, H/o previous coronary artery disease 4.9%, 2 pts had past H/o of malignancy and 1 pt was having rheumatic valvular disease, as shown in Table 4.

 

Table 4: Frequency and percentage of stroke risk factors

 

Type of stroke

In our study as shown in Table 5, 178 pts (74.8%) suffered ischemic stroke and 54 pts (22.7%) suffered hemorrhagic stroke followed by 6 pts (2.5%) were due to some primary brain malignancy or secondaries in brain. So most common type of stroke was ischemic that is cerebral infarction. Out of 178 ischemic stroke pt 111 (46.8%) were males and 67 (28.3%) were females. Second most common type of stroke was hemorrhagic (22.7%). Out of 54 hemorrhagic stroke pts 27 (11.4%) were males and same numbers were females. Stroke due to space occupying lesion either due to primary brain malignancy or secondaries in brain was 2.5%.

Topographic distribution of hemorrhage

In our study most common site of hemorrhage was thalamus (24.7%) followed by ventricular (17.5%) and basal ganglia (13.4%), as shown in Table 6.

DISCUSSION

The mean age observation of 61 in our study which correlates with study done by Maskey et al. (mean age 63) and Awad SM et al. (mean age 63.66). The common age group involved was between 61-70 years which closely correlates with study done by Ukoha Ob et al. and Maskey et al.⁷ Young stroke (age ≤45 years) comprised of 15% of all pts witch closely correlates with study done by Abdu Sallam et al. (13.6%), Gauri et al. (19%), P. Chitrambalam et al. (20%). The male to female ratio was 1.4:1.⁸ Which correlates with study of Aiyar et al. (1.9:1). So it can be concluded that incidence of stroke is more common in male sex which correlates with study done by Aiyar et al, Pinhero et al., Eapen et al.⁹ In our study most common clinical presentation was hemiplegia which was followed by speech involvement. This observation closely correlates with the study done by P. Chitrambalam et al., in which most common was hemiplegia (in <45 years 93.3%, in >45 years 89.2%) followed by speech involvement (in <45 years 43.3%, in >45 years 30.8%).¹⁰ In our study most common risk factor was hypertension was the commonest risk factor which correlates with the study done by Eapen et al. (40%), Abdu-Alrhaman Sallam et al. (67%). H/o past cerebrovascular accident accounted for 15% which correlated with study done by Ukoha Ob et al.¹¹ (16.2%) and by Abdu-Alrhaman Sallam et al. (12.2%). In our study percentage of smoking and alcohol were less as compared to other studies. The likely explanation is this being a retrospective study in few case histories those data was not filled properly by emergency duty doctors attending those patients. In our study dyslipidemia was 13.4% which was correlating with study done by Eapen et al. (17%), Abdu-Alrhaman Sallam et al. (13.9%). In our study diabetes pts were 9.3% which correlates with study done by Maskey et al. (9.3%), Gauri et al. (9%) and Eapen et al. (8%). In our study pts with previous H/o coronary artery disease were 4.9% which co related with study done by Kaur et al. (6%) and Eapen et al. (9%).¹² In our study most common type of stroke was ischemic that is cerebral infarction (74.8%) which correlated with studies done by Aiyar et al. in which infarction was in 70%, in Eapen et al. 68% and in Devichand et al. (75%).¹³ Second most common type of stroke was hemorrhagic (22.7%) which correlated with study done by Eapen et al. (32%), Aiyar et al. (26%), Devichand et al. (25%). Stroke due to space occupying lesion either due to primary brain malignancy or secondaries in brain was 2.5% which correlated with study by Aiyar et al. (4%). In our study most common site of hemorrhage was thalamus (24.7%) followed by ventricular (17.5%) and basal ganglia (13.4%). This findings correlates with study done by Eapen et al. and Aiyer et al. where it has been concluded that in multiple hematoma sites most common was thalamic ganglionic region.¹⁴  In our study most common site of infarct was parietal (33.7%), followed by frontal (16.7%) followed by basal ganglia (10.5%). This observation was consistent with study done by Eapen et al., in which most common site was parietal (56%) followed by basal ganglia and frontal. These findings were favoring middle cerebral artery territory; this was also confirmed in study done by Devichand et al. and Caroli et al.¹⁵

 

CONCLUSION

To conclude stroke in our county is on rise. The occurrence rises with age with peak between 60 to 70 years. Young pts (age ≤45 years) were 15% of pts which is more dangerous in view of productive year lost. This study showed male predominance in stroke cases. Cerebral infarction was more than hemorrhage. Males were more affected than females in ischemic stroke but for hemorrhage, incidence was equal. Hypertension was amongst leading risk factors for both types. After hypertension previous H/o CVA, smoking, dyslipidemia, DM and alcohol intake and previous H/o CVA were amongst leading risk factors, they were more prevalent in ischemic stroke. Most common clinical presentation was hemiplegia followed by speech involvement. In cerebral infarction most common site was parietal followed by frontal, basal ganglia, temporal and occipital. In hemorrhage most common site was thalamus followed by ventricular, basal ganglia and parietal.

 

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