STROKE

Dr Ubaid N P

Community Medicine

Pariyaram Medical College

Introduction

• Acute severe manifestations of cerebrovascular disease

• WHO definition – “rapidly developed clinical signs of focal disturbance of cerebral function; lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin”

• TIA, subdural hemorrhage, tumors, poisoning or trauma are excluded

• Caused by three morphological abnormalities – stenosis, occlusion or rupture of arteries

• Signs and symptoms are related to extend and site of the area involved and to the underlying causes

• Coma, hemiplegia, paraplegia, monoplegia, multiple paralysis, speech disturbances, nerve paresis, sensory impairement etc.

Aetiology

A. Ischaemic stroke

- Lacunar infarct

- Carotid circulation obstruction

- Vertebrobasilar obstruction

B. Hemorrhagic stroke

- Spontaneous intracerebral hemorrhage

- Subarachnoid hemorrhage

- Intra cranial aneurysm

- Arteriovenous malformation

• Cerebral thrombosis followed by hemorrhagic stroke is the most common form of stroke

• Worldwide 6.1 million deaths, 10.8% of all deaths (2008)

• Prevalence rate in India – 1.54/ 1000 population

• Highest risk of death in the first weeks after the event

• Survivors may have – no disability to mild, mod or severe disability

• Considerable spontaneous recovery can occur up to about 6 months

• Patients are at high risk for subsequent event of around 10% in first year 5% the year thereafter

Risk factors

• Hypertension• Cardiac abnormalities – LVH, Dilatation• Diabetes• Elevated blood lipids• Obesity• Smoking• Glucose intolerance• Oral contraceptives etc

Host factors

• Age : can occur in any age, globally more in age >70 years, India – strokes in the young

• Sex: M > F

• Personal history : a/w diseases, esp. CVS disease and diabetes

Stroke Control Programme• Community level effective measures for the prevention of

stroke

• Control of arterial hypertension

• Early detection and treatment following TIA

• Management of other risk factors

• Control of complications

• Facilities for long term follow up of patients

• Reliable knowledge and extend of the problem in the community