Veni, A (2013) Comparison of extra cranial with intra cranial carotid artery disease in ischemic stroke. Masters thesis, Madras Medical College, Chennai.
|
Text
1601001 13veni.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: Stroke is defined as developing symptoms or and signs of global or focal, loss of cerebral function with symptoms lasting for more than 24 hours or leading to death with no apparent cause other than vascular origin. Globally, the rate of occurrence of stroke is estimated as 400 - 800 per lakh of population. Around 57 lakh deaths occur due to stroke in a year. Approximately, 1.6 crore new acute strokes are reported yearly. Worldwide, stroke mortality is high in Eastern Europe and Asia. In India, the rate of occurrence of stroke is estimated as 90 - 222 per lakh of population. Approximately, 14 – 16 lakhs new acute strokes are reported yearly. 12% of them occur in the age group of less than 40 years. In fact, it is estimated that the incidence of stroke will reach one million annually by the year 2050. Stroke is a leading cause of long term disability in our society. As the longevity of the population increase, the incidence is on the rise. Adoption of western diet may further increase the prevalence and incidence of cardiovascular disease and stroke. Of the hundreds and thousands of stroke survivors each year, approximately 30% need support for day- to-day activities 20% need assistance with ambulation and 16% require institutional care. Hence the need for identifying stroke risk factors to the reduce morbidity and mortality due to stroke. AIM OF THE STUDY: To assess the following in patients with anterior circulation ischemic stroke: 1. Risk factors involved in carotid artery stroke. 2. Clinical profile, pattern of vascular involvement in carotid artery stroke. 3. Extra cranial internal carotid artery disease by carotid doppler. 4. Intracranial carotid artery disease by transcranial doppler in patients who showed extracranial internal carotid artery disease. 5. Comparing the concordance and discordance of carotid artery disease in extracranial and intracranial part of internal carotid artery. MATERIALS AND METHODS: This cross sectional study was conducted during Jan 2011 to Oct 2012 at Madras Institute of Neurology, Rajiv Gandhi Government General Hospital, and Chennai. Patients with clinical features suggestive of stroke were enrolled in this study; all were subjected to CT Brain, MRI Brain and Carotid Doppler. Inclusion Criteria: 1. All the patients with clinical feature suggestive of stroke, 2. Imaging showing ischemic infarct in the anterior circulation, 3. Carotid Doppler showing atherosclerotic carotid artery disease, 4. Patients with anterior circulation TIA. Exclusion Criteria: 1. All hemorrhagic strokes, 2. Posterior circulation stroke, 3. Patients without carotid artery disease on carotid doppler, 4. Patients with cardiac disease. RESULTS: Among the total 485 patients, 150 patients (30.9%) with posterior circulation stroke or venous infarcts, intra cerebral hemorrhage were excluded from the study. Remaining 335 patients were subjected to cardiac evaluation, of them 23 patients (6.8%) who showed cardiac abnormalities were excluded from the study. Out of the 312 patients only 70 patients who showed carotid artery disease in carotid doppler were enrolled in this study and subjected to transcranial doppler to study the intra cranial part of internal carotid artery involvement. CONCLUSION: 1. The common risk factors for carotid artery disease in our study are dyslipidemia, systemic hypertension, diabetes mellitus, smoking and alcohol consumption, in the order of occurrence. 2. Incidence of transient ischemic attack was high in patients with intracranial carotid artery disease indicating the need for intensive management of these patients to prevent morbidity and mortality 3. The most common radiological presentation is the territorial infarct involving the middle cerebral artery territory followed by watershed infarcts. 4. Most of the patients with extracranial internal carotid artery disease also had co-existing intracranial internal carotid artery disease which in turn may further lead to stroke. This emphasizes the need to search for intracranial disease in patients with extra cranial carotid artery disease. 5. Transcranial doppler can be used as a noninvasive initial screening tool for detecting intracranial internal carotid artery stenosis before considering any invasive investigation.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | Reg.No.16101011 |
| Uncontrolled Keywords: | extra cranial, intra cranial carotid artery disease, ischemic stroke, Comparison study. |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Mar 2020 08:12 |
| Last Modified: | 27 Mar 2020 08:12 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12487 |
Actions (login required)
 |
View Item |
