Prevalence, pattern, risk factors and outcome of stroke in women: a clinical study of 100 cases from a tertiary care center in South India

Background: Stroke is the leading cause of acquired disability and the third leading cause of death in women worldwide. There had been relatively few studies of stroke in women. Objective of the study was to study the prevalence, patterns, risk factors and outcome of stroke in women. A cross sectional study with case control comparison and prospective follow up at one month at ESIC Super speciality hospital, Hyderabad in South India. Methods: Total 100 stroke patients were identified over a period of 3 months and data collected on the basis of clinical proforma developed for the purpose. Results: Of 100 stroke patients, 31 were females. Ischemic stroke was seen in 25 (80.64%) females. Age was an important non-modifiable risk factor for stroke. Stroke was predominant among older women 23 (74.19%). Mean age of stroke in females was 57 years. Menopause 27 (87.09%) was the predominant risk factor followed by hypertension in 25 (80.6%), dyslipidemia in 19 (70.3%) physical inactivity in 17 (54.8%) and diabetes in 12 (38.7%) females respectively. Majority of females 27 (87.09%) were uneducated as compared to males 27 (39.13%). The overall mortality in females was 3 (9.6%) as compared to males 3 (4.3%). 25 (89.2%) of females were ambulatory when compared to males 62 (93.9%). Conclusion: Stroke was common in older women and ischemic stroke was the predominate type of stroke. Physical inactivity was the significant risk factor in women when compared to men. Women are more likely to be disabled after stroke than men. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

Trial of ORG 10172 in acute stroke treatment classification and associated risk factors of ischemic stroke: a prospective study from a tertiary care center in South India

Background: Stroke is the leading cause of acquired disability worldwide. Better understanding of risk factors helps to reduce the community burden of stroke. Aim of the study was to determine pattern of ischemic stroke subtype and associated risk factors.Methods: Of 220 patients with first ever stroke, 168 patients of ischemic stroke were enrolled prospectively from January 2016 to May 2016 at ESIC Superspeciality hospital, Hyderabad. Patients were categorized in accordance with the Trial of Org 10172 in Acute Stroke treatment (TOAST) criteria.Results: Of 168 patients, 110 (65.4%) were males; male to female ratio was 1.8:1. The mean age was 53.912.3 years. Small vessel occlusion (SVO) occurred in younger age group as compared to other stroke subtypes. Frequency of large-artery atherosclerosis (LAA) (46.4%) was highest (Extracranial: 41.1%, intracranial: 36.9%), followed by SVO (32.4%), cardio embolism (15.4%), undetermined (4.7%) and other determined causes (1.1%). Risk factors included dyslipidemia (79%), hypertension (67.8%), smoking (58.3%), alcohol use (54.7%), diabetes (40.4%) and physical inactivity (27.3%). Common association observed was smoking (P - 0.004) and alcohol (P - 0.003) with LAA and SVO, and dilated cardiomyopathy with cardio embolism.Conclusions: LAA was observed frequently than SVO. Frequency of SVO was lower than Asian but higher than western, while cardio embolism was lower than Western and similar to Asian stroke studies. Dyslipidemia was the predominant risk factor than hypertension reported from Asian and Western stroke registry. This unique pattern can be attributed to differences in demographic and risk factor profiles. The study confirms the need for vigorous primary and secondary prevention measures targeting modifiable risk factors of stroke

Extracranial carotid artery wall abnormalities in patients with acute ischemic stroke

Background: Stroke is the second most common cause of mortality worldwide. Large artery extracranial atherosclerosis is one of the major causes of ischemic stroke. The present study laid emphasizes on causal relationship between the carotid wall abnormalities and occurrence of ischemic stroke. The aim and objectives of the study were to estimate the prevalence of carotid artery wall abnormalities in acute ischemic stroke patients and assessment of association between carotid wall abnormalities and vascular risk factors.Methods: A cross-sectional observational study was conducted in department of neurology for a period of two years. Cases with acute ischemic stroke were included in the study. Carotid Intima media thickness (CIMT) was measured using carotid duplex ultrasound scanning at the level of carotid bifurcation.Results: CIMT findings was abnormal in 87% of cases where the thickness was ≥0.8 mm. 38% of patients with Ischemic stroke had CIMT ≥1.2 mm. Mean CIMT was highest in patients with sedentary life style (CIMT-1.18 mm) and the differences were significant when compared to non-sedentary life style group. CIMT values were higher in patients with age 61-80 years (CIMT: 2.1 mm); with multiple vascular risks like diabetes and hypertension (CIMT: 1.16 mm); with diabetes mellitus alone (CIMT: 1.14 mm) and hypertension alone (CIMT-1.13 mm) respectively.Conclusions: Highest mean CIMT value were observed in older adults with age range of 61 to 80 years. Individuals with sedentary life style habits and multiple vascular risk factors had higher mean CIMT value. Early identification of abnormal CIMT value combined with appropriate treatment can prevent stroke in future

Aetiopathogenesis of ischemic stroke in rheumatoid arthritis: a case series study from tertiary care centre of South India

Stroke is a major health concern worldwide. Published meta-analyses showed significant higher risk of ischemic and hemorrhagic stroke in patients with rheumatoid arthritis (RA) compared to the general population. Major etiopathogenesis of ischemic stroke in RA is non-atherosclerotic vasculopathy. Here the authors described varied aetiopathogensis of ischemic stroke in patients with RA which had been seldom reported in the literature. It was one of the first case series which threw light in this genre. Observational, prospective case series study was conducted over a period of one year. Amongst four cases presenting as an ischemic stroke with co-existing RA; each patient had a medium or small vessel vasculopathy, which had never been described earlier. Case 1 had cardio embolic source plus large vessel vasculopathy, case 2 had intracranial non-atherosclerosis vasculopathy; case 3 had secondary Moya-Moya disease; case 4 had both intracranial and extra cranial vasculopathy. Underlying aetiopathogensis of stroke in patients with RA can be attributed to insufficient cardiovascular treatment (well described in the literature) and vasculopathy of extracranial and intracranial vessels and secondary Moyamoya disease due to RA. Thorough evaluation is needed to prevent recurrence of stroke. The treatment strategy in these patients are immunotherapy apart from the conventional therapy with antiplatelet and statins

Clinical Aspects of Moyamoya Disease

Moyamoya disease is a chronic progressive, non-atherosclerotic, occlusive intracranial vasculopathy involving major cerebral arteries around the circle of Willis. MMD occurs frequently in East Asian populations but the disease can affect the American and European ethnicities as well. Knowledge of clinical aspects of Moyamoya disease (MMD) is important in view of distinctive clinical presentation observed in children and adults. MMD has bimodal age of distribution, with peaks in the first and last decades of life. Childhood MMD is characterised by Ischemic manifestation (Transient ischemic attack, Cerebral Infarction), whereas adult MMD presents with hemorrhagic manifestations (Intracerebral haemorrhage, Intraventricular bleed). Refractory headache, seizure and ophthalmological abnormalities are other clinical presentations of MMD. A high index of clinical suspicion and an eye to recognise the common as well as unusual manifestations of the disease and inciting events may prevent delay in the diagnosis. A thorough knowledge about the varied clinical presentation would aid clinician for early diagnosis and management of this rare entity. The present article provides extensive review on the clinical aspects of MMD amongst adults and paediatric population, on the basis of previous articles and research studies

Blood lipid levels, statin therapy and risk of intracerebral hemorrhage versus ischemic vascular events: a prospective case control study from tertiary care center of south India

Background: Intracerebral hemorrhage (ICH) is characterized by high mortality and morbidity. A little is known about the association between blood lipids, statin use and risk of ICH. Objective of the study was to investigate the relation between blood lipid levels and risk of hemorrhagic stroke.Methods: Prospectively compared the lipid levels of primary ICH patients (case) with ischemic group (control) patients, i.e. age and sex matched individuals admitted from January 2014 to January 2015 and outcome analyzed.Results: Of the 678 acute stroke patients, 78 (11.5%) had ICH who was enrolled. Mean age was 53±14.4. ICH was frequent in older age (57.6%) with male gender predominance (73%). Most frequent location of bleed was in thalamus (30.7%). Low density lipoprotein (LDL), triglyceride (TG) and very low density lipoprotein (VLDL) cholesterol were significantly low in ICH patients compared to controls. There was no significant difference in the high density lipoprotein (HDL) levels in both groups. Mean total cholesterol was significantly low in a subset of study group that included male gender, younger onset stroke (<50 years) and with prior history of hypertension. Subgroup analysis in ICH group showed significantly low mean total cholesterol, LDL and TG cholesterol in statin group compared to non-statin group.Conclusions: Lower blood lipid levels are associated with an increased risk of ICH. The reduction of blood lipids due to statin therapy might increase the risk of ICH, especially in hypertensive individuals and those with alcohol use; hence there should be a cautious use of statins

Intracranial massive subdural haematoma: a potentially serious consequence of diagnostic lumbar puncture

Intracranial subdural haematoma (SDH) is an exceptionally rare complication of lumbar puncture (LP) and cerebrospinal fluid (CSF) drainage. Post LP headache mostly has a benign course, but it can also be a manifestation of a potentially life-threatening complication such as SDH. Only a few cases has been reported in literature. We report a case of massive intracranial SDH in a young male following LP and CSF drainage

Prevalence, pattern, risk factors and outcome of stroke in women: a clinical study of 100 cases from a tertiary care center in South India

Background: Stroke is the leading cause of acquired disability and the third leading cause of death in women worldwide. There had been relatively few studies of stroke in women. Objective of the study was to study the prevalence, patterns, risk factors and outcome of stroke in women. A cross sectional study with case control comparison and prospective follow up at one month at ESIC Super speciality hospital, Hyderabad in South India.Methods: Total 100 stroke patients were identified over a period of 3 months and data collected on the basis of clinical proforma developed for the purpose.Results: Of 100 stroke patients, 31 were females. Ischemic stroke was seen in 25 (80.64%) females. Age was an important non-modifiable risk factor for stroke. Stroke was predominant among older women 23 (74.19%).  Mean age of stroke in females was 57 years. Menopause 27 (87.09%) was the predominant risk factor followed by hypertension in 25 (80.6%), dyslipidemia in 19 (70.3%) physical inactivity in 17 (54.8%) and diabetes in 12 (38.7%) females respectively. Majority of females 27 (87.09%) were uneducated as compared to males 27 (39.13%). The overall mortality in females was 3 (9.6%) as compared to males 3 (4.3%). 25 (89.2%) of females were ambulatory when compared to males 62 (93.9%). Conclusion: Stroke was common in older women and ischemic stroke was the predominate type of stroke.  Physical   inactivity was the significant risk factor in women when compared to men. Women are more likely to be disabled after stroke than men.

Cerebral sinus venous thrombosis

Background: Intracranial Sino venous occlusive disease is an infrequent condition and accounts only 0.5-1% of all strokes. Objective of the study was to know the prevalence, pattern and risk factors involved in patients of cerebral sinus venous thrombosis (CSVT).Methods: Hospital databases were searched retrospectively and patients diagnosed with CSVT from December 2014 to February 2016 were identified. Data on clinical presentation, risk factor, cerebral sinus involved, hospital stay and outcome were analyzed.Results: Fifteen patients (3.4%) were identified as CSVT out of a total acute stroke case of 430. Mean age of patients was 31 years and 11 (73.3%) were males. The presenting symptoms included headache (n=14), altered sensorium (n=1) and seizures (n=5); signs included hemi paresis (n=4), papilledema (n=8) and bilateral VI nerve palsy (n=3). Majority had aseptic CSVT (n=14), and one patient had septic CSVT associated with tuberculous meningitis (TBM). Radiological findings included brain parenchyma involvement (n=8), subdural hematoma (SDH) (n=1), subarachnoid haemorrhage (SAH) (n=1) and normal brain parenchyma (n=5). Multiple cerebral sinuses were involved in seven patients. Most common site of CSVT was observed in sigmoid sinus. Risk factors included hyperhomocystenemia (n=3), protein S deficiency (n=8), protein C deficiency (n=6) and antithrombin III deficiency (n=3) as primary hypercoagulable state. ANA positive was observed in one patient and four had history of alcohol use. All fifteen patients received low molecular weight heparin (LMWH) for 1 week along with bridging oral anticoagulant. None of the patients required intrasinus thrombolysis and decompression surgery. Average hospital stay was 9 days. All had modified Rankin scale (MRS) ≤ 2 at 6 months follow up.Conclusions: Prevalence of CSVT is higher than that reported from Asian studies. Younger age and male predominance was observed. Protein S deficiency was the major risk factor for CSVT

Dietary pattern in Adult Patients with Acute Stroke in South India: A Case-Control Study from a Tertiary Care Center in Hyderabad

Background and Objective: Diet plays a crucial role in the occurrence of stroke. But very few studies have so far been conducted with focus on this aspect of acute stroke in India. The objective of the study was to identify the dietary pattern in patients with acute stroke in South India. Materials and Methods: Patients with first-ever acute stroke (ischemic and hemorrhagic) admitted between June 2017 and November 2017 were enrolled and compared with age- and sex-matched controls. Information was collected using a pro forma. Results: Out of 293 acute stroke patients, 150 were enrolled and compared with 150 controls. The mean age was 52.3 ± 12.6; years 112 (74.6%) patients were male. The majority of them were on traditional diet that included a daily intake of rice (98.6%) and pulses (40.6%). Hypertension (73.3%) was the major vascular risk factor for stroke (P < 0.0001). Significant differences were observed in risk factors such as diabetes (P < 0.0001), smoking (P = 0.0001), alcohol use (P = 0.0017), and heart disease (P = 0.0002), when stroke patients were compared with controls. Stroke patients reported a lower intake of green leafy vegetables (P = 0.0001; odds ratio [OR] 0.17), roots and tubers (P = 0.0016; OR 0.21), and fruits (P = 0.0022; OR 0.29). There was at the same time a higher intake of red meat products (P = 0.04; OR 2.41), organ meats (P = 0.0093; OR 4.35), fried snacks (P = 0.0038; OR 2.01), and pickles (P = 0.04; OR 1.81) although the data suggested lesser consumption of prawn and crab (P = 0.04; OR 0.55) and water (P = 0.0001 OR 4.59) among stroke patients. Higher consumption of fruit juices (P = 0.0008) and junk foods (P = 0.03) was observed in young stroke patients (age ≤45 years) whereas the intake of chicken (P = 0.03) and alcohol (P = 0.0001) was observed to be more among men than among women. Conclusion: Majority of stroke-afflicted patients in South India consume white rice and dal. There is lower intake of water, green leafy vegetables, and fruits and higher consumption of red meat, organ meat, and pickles among stroke patients