Comparitive Study on Clinical Profile of Stroke in Males and Females

Vidhya, K (2011) Comparitive Study on Clinical Profile of Stroke in Males and Females. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Stroke is one of the most important non- communicable disease of public health importance. Stroke is defined as an abrupt onset of a focal neurological deficit that is attributable to a focal vascular cause. WHO (World Health Organization) defines the syndrome of stroke as ―rapidly developing clinical signs of focal or global disturbance of cerebral function with symptoms lasting or leading to death, with no apparent cause other than vascular origin. It includes: 1. Sub arachnoid hemorrhage. It excludes: 1. Transient ischemic attack, 2. Subdural hematoma, 3. Subdural hemorrhage, 4. Infarction caused by infection or tumor. Stroke represents the third leading cause of death after Coronary artery disease and Cancer in the west with overall prevalence of 800 per lakh population. There is a lack of reliable information on epidemiology of stroke in our country. But community surveys from different regions of India showed a Crude Prevalence Rate of stroke presumed to be of vascular origin in the range of 203 per lakh population. Stroke is a result of series of insult to cerebral and cardiovascular systems. The insult comes in the form of risk factors which appreciably differs for different communities. Stroke prevention strategies now revolve around the management of these risk factors which forms the backbone of the management of stroke in current era. Socioeconomic factors, dietary habits, lifestyle behaviors, different patterns of risk factors and environmental conditions have shown varying incidence of stroke observed in different parts of the world. Present statistics are in major part contributed by the studies from the developed countries. Since various ethnic groups and communities exists in our country, we need more studies from our nation involving large population to find out the corresponding incidence, prevalence, morbidity, mortality, risk factors and outcome. This will enable us to devise our own strategy in the primary prevention of stroke for our population. Stroke is a leading cause of disability in adults of stroke survivors. Of the 100 stroke survivors 30 % requires assistance with activities of daily living, 20 % requires assistance for ambulation and 16 % requires institutional care. Hence both directly and indirectly there is an appreciable loss of national economy. AIMS OF THE STUDY: To make a comparative study on clinical profile of stroke in males and females with regard to variability in; • Age Predilection, • Clinical presentation, • Type of stroke, • Frequency of risk factor in each group, • Outcome difference during the hospital stay. MATERIALS AND METHODS: Study Place: Dept. Of Medicine, Govt. Stanley Medical College, Chennai. Study Design: Prospective Cross Sectional Observational Study. Study Population: 50 Males and 50 Females. Inclusion Criteria: All patients admitted with sudden onset of focal neurologic deficit attributable to a focal vascular cause. Exclusion Criteria: 1. Patients not satisfying the above said criteria. 2. Patients with an already existing focal neurological deficit. 3. Patients with subdural hemorrhage or extradural hemorrhage. RESULTS: In the study titled ―Comparative study of stroke in males and females, 50 males and 50 females were enrolled based on the framed inclusion and exclusion criteria. They were analyzed according to their age, clinical features, risk factors, type of stroke and outcome. In both the sexes, ischemic stroke was the commonest type of stroke accounting for 80 % of the total. Out of the 50 males, 15 males had hemorrhagic stroke (30 %) and 35 males had ischemic stroke (70 %). Among the females studied, 5 females had a hemorrhagic stroke (10 %) and 45 females (90 %) had ischemic stroke depicting the higher incidence of hemorrhagic stroke in males. Of the hemorrhagic strokes, 87% was caused by cerebral bleed and rest 13 % by the subarachnoid hemorrhage. CONCLUSIONS: Ischemic stroke was the most common type of stroke in both sexes. Hemorrhagic stroke was more common in males than females. Of the hemorrhagic strokes, intracerebral bleed was more common than subarachnoid hemorrhage. Mean arterial blood pressure was higher in patients with hemorrhagic strokes than ischemic strokes and showed no difference between the groups. The mean age of presentation of stroke in males was 54.6 and that in females was 60.1. Females had later peaking of incidence when compared to males. Among the stroke in young, the case clustering in females was in the third decade, whereas in males was in the fourth decade. The most common clinical presentation of stroke was motor deficit followed by seventh cranial nerve paralysis and altered sensorium. There was no disparity between males and females in this regard. The presentation of altered sensorium, headache, vomiting, and seizures were more common in hemorrhagic stroke than ischemic stroke. Among these females predominated over males with altered sensorium and headache whereas males predominated over females with vomiting and seizures. Ataxia and rest of cranial nerve palsy was more common in males than females. The most common type of stroke syndrome in both the sexes were LACS, next being TACS. PACS presented more in females and POCS presented more in males. Among the hemorrhagic strokes, the most common clinical syndrome was TACS. All the female cases belonged to this type. Even though the commonest clinical presentation in males was also TACS, some presented with LACS and PACS. Systemic hypertension is the commonest risk factor attributable to stroke in females, whereas smoking formed the predominant risk factor in males. Systemic hypertension was the most commonly associated risk factor for stroke in the total population. There was a higher frequency of hypertension in females than males. It formed the leading risk factor for stroke in females. Hypercholesterolemia has been associated in females more than that of males reflecting the post menopausal effect on the lipid profile. It was predominantly associated with ischemic stroke. Smoking was more commonly associated in males than females reflecting the altered behavioral pattern in males. Smoking as a risk factor in males is more significantly associated with infarcts than hemorrhagic stroke. Smoking therefore formed a leading causal factor among male infarcts. Major proportions of the male population in our study were alcoholics. Alcoholism as a contribution for causation of stroke was significantly high for hemorrhagic stroke than that for infarct. One female alcoholic was present in our study, who sustained a hemorrhagic stroke. Diabetes affected more females than males and contributed more towards infarct than hemorrhage in both the sexes. Coronary artery disease was more commonly associated with male than females. Left ventricular hypertrophy is more commonly associated with female than male possibly due to the higher incidence of hypertension in females in our study. Atrial fibrillation has been associated more in the females than the males possibly due to the higher incidence of rheumatic heart disease in females in our country. Young stroke in females was predominantly observed with the post partum females, major proportion due to cortical venous thrombosis. Among the infarcts, mortality rates were higher in females than males possibly due to the later age of presentation and other potential risk factors that are related to age, but in total, males had a poorer outcome than females probably due to the increased occurrence of hemorrhagic stroke in males. Patients who presented with TACS had a poorer outcome and that who presented with LACS had good outcome when compared to others. There was no disparity between the groups in this respect. Patients who presented with altered sensorium had a poor outcome, with males showing greater association than females. The most commonly associated risk factor in the poor outcome group in female population was hypertension and that in male population was alcoholism.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Comparitive Study ; Clinical Profile ; Stroke ; Males ; Females.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 18:15
Last Modified: 24 Mar 2018 17:06
URI: http://repository-tnmgrmu.ac.in/id/eprint/6538

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