Comparative study of Risk Factors between Ischemic and Hemorrhagic Stroke

Ravi, G (2006) Comparative study of Risk Factors between Ischemic and Hemorrhagic Stroke. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION Stroke or cerebrovascular accident by definition is a syndrome of rapidly developing clinical signs of focal or global disturbance of cerebral circulation with symptoms lasting 24hrs or longer or leading to death with no apparent cause other than of vascular origin. Disorders of cerebral circulation include any disease of the vascular system that causes ischemia or infarction of the brain or spontaneous hemorrhage into the brain or subarachnoid space. In India, for every 55 seconds one case of stroke has been reported. To presume, for every 5 minutes someone is dying of stroke. Identification and control of modifiable risk factors is the best strategy with excellent choices on the anvil to scale down the incidence of stroke. Also for good measures, the number of cases can be decimated by leaps and bounds. The role of several common factors such as smoking, blood cholesterol, blood glucose, and blood pressure is well established in causing ischemic heart disease but the relations between those risk factors and ischemic stroke have been inconsistent. For example, the role of blood cholesterol in the etiology of ischemic stroke is much less clear. One large collaborative study did not find a clear association between total cholesterol and risk of stroke, but included only fatal strokes and there was no separation of ischemic from hemorrhagic stroke. In order to better define the risk factors of ischemic stroke, it is necessary to more precisely diagnose the patients using comprehensive investigations including neuroimaging as well as cerebrovascular and cardiac evaluation. In Developing countries like India it is very difficult for the patients to afford for the post stroke treatment like taking MRI in the aid of thrombolysis, surgeries for ICH, and other supportive therapies like physiotherapy, speech therapy etc. Because of these shortcomings, we are losing more number of patients than in western countries. Clinical trails showed that if the risk factors like Systemic hypertension, Diabetes mellitus, Dyslipidemia, smoking etc. are modified and treated well in advance, then both the morbidity and mortality rates due to stroke can be brought down to an amazingly lower level. So, it is high time in this new era of medicine to create awareness on these risk factors in a country like ours where health awareness, affordability and medical facilities are low. This observational study encompasses the risk factors associated with ischemic and hemorrhagic stroke with additional note on the mortality rate. OBJECTIVES: 1. To compare the clinical findings and risk factors in cases of hemorrhagic and ischemic stroke comprehensively. 2. To predict the factors determining in hospital mortality outcome of the stroke. MATERIALS & METHODS: This prospective study was conducted in Madras Medical College, Government general hsospital representing mostly of low socioeconocmic rural and urban population with low literacy rate. The present study covered 100cases (57males and 43 females) admitted with the confirmed incidence of stroke defined as rapid onset of a neurological deficit or subarachnoid hemorrhage with deficits persisting for at least 24 hrs. (unless either death ensued within 24 hrs. of symptom onset or CT /MRI showed a lesion consistent with the symptoms) and no underlying brain trauma, tumor or infection to cause the symptoms. Stroke cases were classified as ischemic or hemorrhagic by trained physicians using all available data. When abstractor could not determine type of stroke based on physical diagnosis or imaging reports a study physician in consultation with neurologist reviewed the documentation to classify the stroke type. Inclusion Criteria: 1. Patients with age of more than 45 years were included as most of that age group 2. Patients with CT scan documenting lesion Exclusion Criteria: 1. Stroke in young that is < 45 years. 2. Stroke patients with cardioemboli and venous thrombosis. Methods: A detailed history in each case regarding onset, predisposing factors, and nature of stroke was recorded. This was followed by a detailed clinical examination to look for the GCS and the presence of seizures. Patients were enquired about the risk factors like SHT, DM, smoking and alcohol. Then patients were submitted for other investigations like complete hemogram, blood sugar, Urea, creatinine, Serum electrolytes and X ray chest. Statistical Analysis: Demographic and clinical data wherein Qualitative forms were given frequencies with their percentages. Demographic and clinical data wherein Quantitative forms were given mean and standard deviation. Univariate analysis of Chi-square test and ANOVA F – test was used to find the statistical significant difference between hemorrhage and infarct on demographic and clinical variables. Multivariate analysis of logistic regression was used to find the statistical significance difference between hemorrhage and infarct on demographic and clinical variables. P value less than 0.05 was taken as statistically significant. CONCLUSION : The following are the conclusions of the study: • Ischemic stroke is commoner than hemorrhagic stroke. • Males are commonly affected than females. • Although smoking, alcohol, high LDL and low HDL are strongly associated with ischemic stroke, the independent risk factors for the development of stroke are high LDL and low HDL. • High levels of diastolic blood pressure, LDL – C, total cholesterol are independent risk factors for the mortality in stroke patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ischemic and Hemorrhagic Stroke ; Risk Factors ; Comparative study
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 25 Mar 2018 03:45
Last Modified: 25 Mar 2018 03:45

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