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Shivde S, Badachi S, Deepalam S, Nadig R, Huddar A, Mathew T, Sarma G, Gg SK, Sanjee SS, Kapparath S. Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India. Cureus 2024; 16:e63640. [PMID: 39092397 PMCID: PMC11292294 DOI: 10.7759/cureus.63640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. METHODS This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. RESULTS The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. CONCLUSION Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.
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Affiliation(s)
- Sonia Shivde
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Sagar Badachi
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Saikanth Deepalam
- Intervention Neuroradiology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Raghunandan Nadig
- Neurology, St. John's National Acedemy of Health Sciences, Bengaluru, IND
| | - Akshata Huddar
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Thomas Mathew
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Grk Sarma
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Sharath Kumar Gg
- Radiology, St. John's National Academy of Health Sciences, Bengaluru, IND
| | - Swathi S Sanjee
- Neurology, St. John's National Academy of Health Sciences, Bengaluru, IND
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Varkey BP, Joseph J, Varghese A, Sharma SK, Mathews E, Dhandapani M, Narasimha VL, Kuttan R, Shah S, Dabla S, Dhandapani S. The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis. Ann Neurosci 2023; 30:40-53. [PMID: 37313337 PMCID: PMC10259149 DOI: 10.1177/09727531221115899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 09/29/2023] Open
Abstract
Background The burden of stroke is increasing in India, but there is limited understanding of the distribution of reported risk factors in the Indian setting. It is vital to generate robust data on these modifiable risk factors to scale up appropriate strategies for the prevention of cerebrovascular diseases in this setting. Summary The objective of this study is to estimate the overall proportion of life style risk factors of patients with stroke in the Indian setting. We searched PubMed and Google Scholar and relevant studies published till February 2022 were included. The risk of bias assessment was considered for the study selection criterion in the meta-analysis. The publication bias was evaluated by funnel plots and Egger's test. We identified 61 studies in the systematic review and after quality assessment, 36 studies were included for meta-analysis. Random effect model was used due to the significant inconsistency among the included studies (I2 > 97%). The mean age of the participants was 53.84±9.3 years and patients with stroke were predominantly males (64%). Hypertension (56.69%; 95% CI: - 48.45 - 64.58), obesity (36.61%; 95% CI: - 19.31 - 58.23), dyslipidemia (30.6%; 95% CI: - 22 - 40.81) and diabetes mellitus (23.8%; 95% CI: - 18.79 - 29.83) are the leading intermediate conditions associated with stroke. The Physical inactivity - 29.9% (95% CI: - 22.9 - 37.1), history of tobacco use (28.59 %; 95% CI: - 22.22 - 32.94) and alcohol use (28.15 %; 95% CI: - 20.49 - 37.33) were reported as the behavioral risk factors for stroke in this setting. Key Messages The current meta-analysis provides robust estimates of the life style related risk-factor of stroke in India based on the observational studies conducted from 1994 to 2019. Estimating the pooled analysis of stroke risk factors is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the modifiable risk factors in this setting.
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Affiliation(s)
- Biji P. Varkey
- Department of Neurology, Postgraduate Institute of Medical Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Jaison Joseph
- Department of Psychiatric Nursing, College of Nursing, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | | | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Manju Dhandapani
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India
| | | | - Radha Kuttan
- College of Nursing, Bhopal Memorial Hospital and Research Centre, ICMR, Bhopal, Madhya Pradesh, India
| | - Saleena Shah
- Government College of Nursing Thiruvananthapuram, Kerala, India
| | - Surekha Dabla
- Department of Neurology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India
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Wu Y, Xiong Y, Wang P, Liu R, Jia X, Kong Y, Li F, Chen C, Zhang X, Zheng Y. Risk factors of cardiovascular and cerebrovascular diseases in young and middle-aged adults: A meta-analysis. Medicine (Baltimore) 2022; 101:e32082. [PMID: 36482541 PMCID: PMC9726403 DOI: 10.1097/md.0000000000032082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk factors for cardiovascular and cerebrovascular diseases in young and middle-aged people have not yet been determined. We conducted a meta-analysis to find the risk factors for cardiovascular and cerebrovascular diseases, in order to provide guidance for the prevention of diseases in the young and middle-aged population. METHODS We searched PubMed, Embase, Cochrane Library from the establishment of the database to Mar 2022. We included case-control or cohort studies reporting risk factors for cardiovascular and cerebrovascular disease in young and middle-aged adults. We excluded repeated publication, research without full text, incomplete information or inability to conduct data extraction and animal experiments, reviews and systematic reviews. STATA 15.1 was used to analyze the data. RESULTS The pooled results indicated that increased systolic blood pressure was significantly associated with increased risk of any stroke, ischemic stroke and hemorrhagic stroke. Body Mass Index (BMI), current smoking, hypertension, and diabetes were significantly associated with increased risk of any stroke and ischemic stroke. Atrial fibrillation was only significantly associated with increased risk of any stroke. Increased total cholesterol was significantly associated with an increased risk of ischemic stroke, whereas increased triglycerides were significantly associated with a decreased risk of ischemic stroke. In addition, increased hypertension was also significantly associated with an increased risk of acute coronary syndrome. CONCLUSION Our pooled results show that BMI, current smoking, atrial fibrillation, hypertension, systolic blood pressure, and total cholesterol can be used as risk factors for cardiovascular and cerebrovascular diseases in young people, while triglycerides can be used as protective factors for cardiovascular and cerebrovascular diseases in young and middle-aged adults.
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Affiliation(s)
- Yinghua Wu
- Nursing Department, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Yan Xiong
- Department of General Practice, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Ping Wang
- Department of Urology, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Rui Liu
- Hemodialysis room, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Xiaoling Jia
- Nursing Department, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Yuyan Kong
- Nursing Department, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Fangfang Li
- Department of Orthopedics, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Chen Chen
- Disinfection Supply Center, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Xia Zhang
- Emergency Department, Karamay Central Hospital of Xinjiang, Xinjiang, China
| | - Yuzhen Zheng
- Nursing Department, Karamay Central Hospital of Xinjiang, Xinjiang, China
- *Correspondence: Yuzhen Zheng, Nursing Department, Karamay Central Hospital of Xinjiang, Xinjiang 834000, China (e-mail: )
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Arslan E, Cetinkaya O. Analysis of the demographic characteristics and clinical profile of acute ischemic strokes admitted to the emergency centre in the Somalia population. Afr J Emerg Med 2022; 12:216-224. [PMID: 35719185 PMCID: PMC9188962 DOI: 10.1016/j.afjem.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/20/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Stroke is a leading cause of death and chronic disability worldwide. In Sub-Saharan Africa (SSA), which includes Somalia, stroke represents a significant part of the chronic disease burden. However, there is relatively little data on risk factors, demographics, and clinical profiles. This study aimed to define the etiological, demographic characteristics, classification of stroke and functional status of patients with acute ischemic stroke (AIS) admitted to the emergency centre, and to create projections to evaluate the incidence and genetic aspects of stroke. Methods The study population consisted of patients who applied to the emergency centre between 1 May 2017 and 1 May 2021 and were diagnosed with acute ischemic stroke (AIS). Patient demographics, season of onset, risk factors, laboratory data, imaging results, infarct location, AIS subtype and treatment outcomes were collected, and compared. Results A total of 3,968 patients diagnosed with ischemia stroke were included in the study. The mean age was 51.12 ± 16.43 years, and we reported male predominance (65.7%). While hypertension, hyperlipidaemia, Diabetes mellitus (DM) were more frequent among the risk factors, smoking history and alcohol consumption history were very low. HIV-infected ischemic stroke was detected at a high rate (20.9%) and was common in a relatively young age group (31.8 ± 14.3). Large-artery atherosclerosis (LAA) subtype was detected with a high rate of 67.7%. The most common clot localization was in Supratentorial location (74.3%), and according to OSCP classification, partial anterior circulation infarcts (PACI) subtype (56.3%) was the most common. And these results were again different from other studies. Discussion While the incidence of stroke and especially HIV-associated youthful ischemic stroke continues to increase rapidly in developing countries such as Somalia, with the addition of inadequate primary health care services, stroke has become a major public health problem in African countries regarding its costs at social, psychological, and economic levels.
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Affiliation(s)
- Ebubekir Arslan
- Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Osman Cetinkaya
- Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Eltemamy MA, Tamayo A, Altarsha E, Sedghi A, Pallesen LP, Barlinn J, Puetz V, Illigens BMW, Barlinn K, Siepmann T. Cerebrovascular Risk Profiles in a Saudi Arabian Cohort of Young Stroke Patients. Front Neurol 2021; 12:736818. [PMID: 34867720 PMCID: PMC8632802 DOI: 10.3389/fneur.2021.736818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The constantly increasing incidence of stroke in younger individuals substantiates an urgent need for research to elucidate underlying risk factors and etiologies. Heretofore, the vast majority of studies on stroke in the young have been carried out in European and North American regions. We aimed to characterize cerebrovascular risk profiles in a Saudi Arabic cohort of consecutive young stroke patients. Methods: We retrospectively analyzed data from consecutive ischemic stroke patients aged 15 to 49 years who underwent detailed cardiocerebrovascular evaluation at a tertiary stroke care center in Makkah, Saudi Arabia. Distributions of risk factors and stroke etiologies were assessed in the entire cohort and in two strata of very young (15–40 years) and young to middle-aged patients (41–49) to account for variability in suggested age cutoffs. Results: In the entire cohort [n = 63, ages 44 (34–47) median, interquartile range], dyslipidemia (71.4%) and small vessel occlusion (31.7%) displayed highest prevalence followed by diabetes (52.4%) and cardioembolism (19%). In very young patients, cardioembolism was the most prevalent etiology (27.3%). Risk profiles were similar between both age strata except for a higher prevalence of diabetes among the older cohort (31.8 vs. 63.4%, p = 0.01). Logistic regression identified diabetes as strongest predictor for association to the older strata (odds ratio = 4.2, 95% confidence interval = 1.2–14.1, p = 0.02). Conclusion: Cerebrovascular risk profiles and stroke etiologies in our cohort of young stroke patients differ from those of previous cohorts, suggesting the need for tailored prevention strategies that take into account local epidemiological data on cerebrovascular health.
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Affiliation(s)
- Marwa Ahmed Eltemamy
- Department of Stroke Medicine, Fairfield General Hospital, Manchester, United Kingdom.,Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Neurology, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Arturo Tamayo
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Winnipeg Regional Health Authority (WRHA), Department of Medicine, Section of Neurology, The Max Rady Faculty of Health Sciences, Brandon Regional Health Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Eyad Altarsha
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Annahita Sedghi
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Singh R, Rebello A, Prabhat N, Khurana D. Rare case of bilateral carotid artery dissection presenting with Foix-Chavany-Marie syndrome. BMJ Case Rep 2020; 13:13/11/e239080. [PMID: 33257395 DOI: 10.1136/bcr-2020-239080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Carotid artery dissection is one of the most common causes of ischaemic stroke in young and middle-aged population. We report a case of bilateral carotid artery dissection presenting with opercular syndrome or Foix-Chavany-Marie syndrome. This 46-year-old obese and hypertensive man with a history of fall from bike 1 week prior, presented with sudden onset of anarthria, dysphagia and deviation of angle of mouth. His speech and dysphagia gradually improved over 10 days to normal, but he developed pseudobulbar affect and difficulty in calculations 4 weeks later. MRI showed acute infarcts in bilateral operculum. CT angiography showed dissection in bilateral cervical ICAs. He was managed conservatively with oral anticoagulation, given for 6 months. Probability of dissection must be considered in patients with a history of trauma or falls developing focal neurological deficits. To our knowledge, this is the first case report of bilateral ICA dissection presenting with Foix-Chavany-Marie syndrome.
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Affiliation(s)
- Rajveer Singh
- Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alex Rebello
- Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Prabhat
- Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Khurana
- Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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7
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Zhang N, Zhang L, Wang Q, Zhao J, Liu J, Wang G. Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study. BMC Neurol 2020; 20:424. [PMID: 33225904 PMCID: PMC7681954 DOI: 10.1186/s12883-020-02005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.
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Affiliation(s)
- Nan Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jingwei Zhao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Moond V, Bansal K, Jain R. Risk Factors and Subtyping of Ischemic Stroke in Young Adults in the Indian Population. Cureus 2020; 12:e11388. [PMID: 33312789 PMCID: PMC7725204 DOI: 10.7759/cureus.11388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: To evaluate the risk factors and etiological subtyping of ischemic stroke in young adults in the Indian population. Methods: This is a retrospective study of 160 patients, in the age group of 18 to 45 years with ischemic stroke, registered at a tertiary care hospital in Delhi, India between March 2014 and January 2018. Hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol consumption, previous history of stroke, valvular heart disease, coronary artery disease (CAD), atrial fibrillation, family history, and migraine were considered as the identifiable risk factors. Stroke subtyping was done according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results: The mean age of the patients was 36.2 years with 74% being males. Headache, vomiting, difficulty in speech, and hemiparesis were the common complaints at presentation. Common risk factors identified were hypertension (50%), prior stroke or transient ischemic attack (TIA; 32%), dyslipidemia (25%), family history of stroke (18%), and smoking (15%). The most common TOAST subtype was undetermined (64%), followed by other determined cause (ODC; 20%), and cardioembolism (15%). Conclusion: There is a certain dissimilarity in the risk factors for ischemic stroke in young adults living in developing countries compared to those belonging to developed nations. Primary and secondary prevention targeted at the modifiable risk factors of ischemic stroke is necessary. Cerebral artery dissection, being a prevalent cause of ischemic stroke in young adults, should be carefully evaluated. A more appropriate stroke classification system specifically tailored for younger patients is needed.
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Prabhakar S, Suravarapu S, Mathai D, Renangi S, Challa S. Risk Factors for Stroke in Rural Population of Telangana State of India, an Unmatched Case Control Study. J Neurosci Rural Pract 2020; 11:448-453. [PMID: 32753811 PMCID: PMC7394663 DOI: 10.1055/s-0040-1713291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context Stroke tops the list of causes for acquired disability among adults and is the second leading cause of death worldwide. Evidence from developed countries indicate significant decline in stroke incidence and mortality, attributable to prevention of risk factors in general population. There is limited evidence on risk factors for stroke in rural India. Aims This study aims to ascertain the risk factors for stroke in rural Telangana and provide a guide to health care providers in adopting treatment and prevention strategies. Settings and Design The study was conducted in the Moinabad mandal of Ranga Reddy District, Telangana state of India. This is a population based unmatched case-control study. Methods and Materials All the houses of Moinabad were approached by a door-to-door survey to identify cases. A total of 288 persons were enrolled in the study which included 144 cases and 144 controls. Statistical Analysis To derive age and gender adjusted odds ratios of various risk factors, binary logistic regression analysis was performed. Results The estimated crude prevalence of stroke in Moinabad mandal is 257 per lakh population. Modifiable risk factors identified were, total cholesterol, systolic blood pressure, alcohol consumption, smoking, diastolic blood pressure, low high-density lipoprotein cholesterol, and central obesity as measured by waist circumference. Nonmodifiable risk factors identified were male gender and higher age group. Conclusion The high prevalence of stroke in rural Telangana makes it an important public health challenge for the state. The identified risk factors need to be addressed at population level.
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Affiliation(s)
| | - Sruthi Suravarapu
- Department of Community Medicine, Apollo Medical College, Hyderabad, Telangana, India
| | - Dilip Mathai
- Department of Medicine and Adult Infectious Diseases, Apollo Medical College, Hyderabad, Telangana, India
| | - Shivaiah Renangi
- Department of Community Medicine, Apollo Medical College, Hyderabad, Telangana, India
| | - Sairam Challa
- Department of Community Medicine, Apollo Medical College, Hyderabad, Telangana, India
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Kivioja R, Pietilä A, Martinez-Majander N, Gordin D, Havulinna AS, Salomaa V, Aarnio K, Curtze S, Leiviskä J, Rodríguez-Pardo J, Surakka I, Kaste M, Tatlisumak T, Putaala J. Risk Factors for Early-Onset Ischemic Stroke: A Case-Control Study. J Am Heart Assoc 2019; 7:e009774. [PMID: 30608196 PMCID: PMC6404210 DOI: 10.1161/jaha.118.009774] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Recent studies have shown an increasing prevalence of vascular risk factors in young adults with ischemic stroke (IS). However, the strength of the association between all vascular risk factors and early‐onset IS has not been fully established. Methods and Results We compared 961 patients with a first‐ever IS at 25 to 49 years to 1403 frequency‐matched stroke‐free controls from a population‐based cohort study (FINRISK). Assessed risk factors included an active malignancy, atrial fibrillation, cardiovascular disease, current smoking status, a family history of stroke, high low‐density lipoprotein cholesterol, high triglycerides, low high‐density lipoprotein cholesterol, hypertension, and type 1 and type 2 diabetes mellitus. We performed subgroup analyses based on age, sex, and IS etiology. In a fully adjusted multivariable logistic regression analysis, significant risk factors for IS consisted of atrial fibrillation (odds ratio [OR], 10.43; 95% confidence interval [CI], 2.33–46.77], cardiovascular disease (OR, 8.01; 95% CI, 3.09–20.78), type 1 diabetes mellitus (OR, 6.72; 95% CI, 3.15–14.33), type 2 diabetes mellitus (OR, 2.31; 95% CI, 1.35–3.95), low high‐density lipoprotein cholesterol (OR, 1.81; 95% CI, 1.37–2.40), current smoking status (OR, 1.81; 95% CI, 1.50–2.17), hypertension (OR, 1.43; 95% CI, 1.17–1.75), and a family history of stroke (OR, 1.37; 95% CI, 1.04–1.82). High low‐density lipoprotein cholesterol exhibited an inverse association with IS. In the subgroup analyses, the most consistent associations appeared for current smoking status and type 1 diabetes mellitus. Conclusions Our study establishes the associations between 11 vascular risk factors and early‐onset IS, among which atrial fibrillation, cardiovascular disease, and both type 1 and 2 diabetes mellitus in particular showed strong associations.
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Affiliation(s)
- Reetta Kivioja
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Arto Pietilä
- 2 National Institute for Health and Welfare Helsinki Finland
| | - Nicolas Martinez-Majander
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Daniel Gordin
- 3 Abdominal Center Nephrology University of Helsinki and Helsinki University Central Hospital Helsinki Finland.,4 Folkhälsan Institute of Genetics Folkhälsan Research Center Helsinki Finland.,5 Joslin Diabetes Center Harvard Medical School Boston MA
| | - Aki S Havulinna
- 2 National Institute for Health and Welfare Helsinki Finland.,8 Institute for Molecular Medicine Finland (FIMM) University of Helsinki Helsinki Finland
| | - Veikko Salomaa
- 2 National Institute for Health and Welfare Helsinki Finland
| | - Karoliina Aarnio
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Sami Curtze
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Jaana Leiviskä
- 6 Department of Clinical Chemistry University of Helsinki and Helsinki University Hospital HUSLAB Helsinki Finland
| | | | - Ida Surakka
- 2 National Institute for Health and Welfare Helsinki Finland.,8 Institute for Molecular Medicine Finland (FIMM) University of Helsinki Helsinki Finland
| | - Markku Kaste
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
| | - Turgut Tatlisumak
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland.,9 Department of Clinical Neurosciences Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Sweden.,10 Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jukka Putaala
- 1 Clinical Neurosciences University of Helsinki and Department of Neurology, Helsinki University Hospital Helsinki Finland
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11
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
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12
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Zhao L, Wang L, Lu M, Hu W, Xiu S. Hyperglycemia is associated with poor in-hospital outcome in elderly patients with acute ischemic stroke. Medicine (Baltimore) 2019; 98:e16723. [PMID: 31374068 PMCID: PMC6709290 DOI: 10.1097/md.0000000000016723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Fasting hyperglycemia is associated with poor neurologic outcome in acute ischemic stroke (AIS), but its relationship with in-hospital outcome in elderly patients remains largely unknown. To assess the association of in-hospital outcome with fasting plasma glucose (FPG) levels at admission in individuals with AIS.This retrospective propensity score-matched case-control study included patients aged over 60 years suffering from AIS and who were admitted to the emergency department from November 2013 to October 2016. Subjects were grouped into the poor-outcome and good-outcome groups based on mortality and intensive care unit (ICU) admission.The poor- and good-outcome groups comprised 74 and 1927 cases, respectively, before propensity score matching (PSM), and 74 and 296 cases, respectively, after PSM. Univariable logistic regression analysis showed that initial FPG after admission was associated with poor in-hospital outcome. Multivariable logistic regression analysis showed that initial FPG after admission was an independent predictor of poor in-hospital outcome (odds ratio = 1.11, 95% confidence interval: 1.037-1.188, P = .003).This study used PSM and strongly suggests that FPG is an independent predictive factor of poor in-hospital outcome in elderly patients with AIS. High initial FPG levels after admission may predict poor in-hospital outcome. Prospective studies are needed to confirm these findings.
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Cui Q, Naikoo NA. Modifiable and non-modifiable risk factors in ischemic stroke: a meta-analysis. Afr Health Sci 2019; 19:2121-2129. [PMID: 31656496 PMCID: PMC6794552 DOI: 10.4314/ahs.v19i2.36] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Stroke is a heterogeneous, multifactorial disease regulated by modifiable and non-modifiable risk factors like total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose and non-modifiable factors like age. Evaluation of these risk factors for ischemic stroke may contribute to more effective prevention. Methods This meta-analysis investigated the data up to 2018 with respect to age, total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose levels in the Ischemic stroke patients and controls. Data from each eligible study was extracted such as year of publication, first author name, ethnicity/country, number of ischemic stroke patients and healthy controls and studies were subjected to heterogeneity analysis. Results Meta-analysis of the modifiable and non-modifiable risk factors like total cholesterol, HDL-C and LDL-C glucose, triglycerides levels and age were not having significantly associated with ischemic stroke (p>0.05). However meta-analysis of triglyceride yielded significant association ischemic stroke with overall 95% CI (−0.62- (−0.09) and P= 0.007 and glucose also showed significant association with ischemic stroke with 95% CI (-1.08- (−0.14), P=0.01. Studies were subjected to heterogeneity which revealed significant heterogeneity with (P<0.00) and I2>96%. Conclusion Meta-analysis revealed that levels of triglyceride and glucose are the predisposing factors for ischemic stroke in the Asian population.
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Affiliation(s)
| | - Niyaz Ahmad Naikoo
- Xingping people's hospital, No.15 jincheng road, xingping city, shaanxi province. China, 713100
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14
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Hussain M, Sharma SR, Jamil MD. A Hospital-Based Study of Stroke in Young from North East India. Ann Indian Acad Neurol 2018; 21:184-187. [PMID: 30258259 PMCID: PMC6137636 DOI: 10.4103/aian.aian_402_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: A study of stroke among young adults and children has recently become a subject of interest. This is because it has a major impact on the individual and society. Studies of stroke in young can lead to therapeutical results affecting both short- and long-term outcomes. Methods: This paper is based on a hospital-based retrospective study, of stroke in young, for a duration of 1 year. Results: The study revealed stroke in young in 31.38% of all strokes, with cerebral infarction in 50.66%, followed by intracerebral hemorrhage in 41.33%, subarachnoid hemorrhage in 4.66%, and cerebral venous thrombosis in 3.33%. The most common presenting symptom was hemiparesis. The most prevalent risk factor for stroke in young was alcohol consumption, followed by traditional risk factors such as hypertension and smoking. Diabetes was detected less in our study. Conclusion: Although traditional risk factors are associated with stroke in young, unfavorable behavioral pattern such as alcohol abuse may cause and promote development stroke in young.
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Affiliation(s)
- Masaraf Hussain
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Shri Ram Sharma
- Department of Neurology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - M D Jamil
- Department of Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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15
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Li X, Tse VC, Au-Doung LW, Wong ICK, Chan EW. The impact of ischaemic stroke on atrial fibrillation-related healthcare cost: a systematic review. Europace 2018; 19:937-947. [PMID: 27209573 DOI: 10.1093/europace/euw093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/12/2016] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to summarize healthcare costs incurred by patients with atrial fibrillation (AF) who developed ischaemic stroke, explore factors associated with increased cost, and highlight the importance of anticoagulation therapy for stroke prophylaxis. A systematic literature search of PubMed, EMBASE, Web of Science, and the health economic evaluation database was conducted up to December 2015. Studies focused on the cost and/or resource utilization of ischaemic stroke in patients with AF were included. Reported costs were converted to international dollars (I$) and adjusted to 2015 values. Alongside the narrative review of included studies, Spearman's correlation, independent-samples t-test, and one-way ANOVA were used to explore factors associated with cost differences between studies. Sixteen studies published from nine countries were identified. Based on currency conversion rates in 2015, ischaemic stroke-related healthcare costs were estimated to be I$41 420, I$12 895, and I$8184 for high-income, upper middle-income, and lower middle-income economies, respectively. Local GDP per capita accounted for ∼50% of the healthcare cost variation among countries. Major component of overall cost was from hospitalization. Ischaemic stroke incurring in patients with AF ≥75 years was 2.3 times that of their younger peers (P = 0.049). The economic burden from ischaemic stroke in patients with AF is considerable with positive association to country income. Clinicians and stakeholders should be aware of the importance of anticoagulation therapies in stroke prophylaxis, the occurrence of stroke, and the downstream economic burden on an increasingly ageing population.
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Affiliation(s)
- Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, China
| | - Vicki C Tse
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, China
| | - Lung Wai Au-Doung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, China.,Research Department of Practice and Policy, School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, China
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16
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Lasek-Bal A, Kopyta I, Warsz-Wianecka A, Puz P, Łabuz-Roszak B, Zaręba K. Risk factor profile in patients with stroke at a young age. Neurol Res 2018; 40:593-599. [PMID: 29577820 DOI: 10.1080/01616412.2018.1455367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background The distribution of risk factors for stroke is related to gender and age. The main objective of study was to determine the type and frequency of stroke risk factors in patients with first-in-life stroke before the age of 50. Methods Our study included patients under the age of 50 with first-in-life stroke. The following data obtained from all participants were analyzed: a neuroimaging of the head, wide panel of blood tests, electrocardiogram, transesophageal echocardiography, ultrasound of the carotid/cerebral arteries. 24-hour ECG monitoring and angio-MRI of head were performed in most patients. Results One hundred and eighty-four patients were qualified into the study; mean age - 39 years (female 45%). The female gender was significantly more often associated with diabetes, carotid/cerebral artery stenosis, myocardial infarction, cardiomyopathy and risk factors associated with lifestyle. More than half of the patients presented at least two risk stroke factors. The most frequent categories of risk factors were related to arteries and metabolic diseases. Vascular risk factors were among the most frequent in individual age categories. Hereditary stroke-burden was significant in the patient before the age of 20.15% of the patients haven't got known stroke risk factor. Conclusions Angiopathy is the most common risk factor for stroke at a young age. More than half of the patients with stroke at a young age have at least two independent risk factors for stroke. In the first two decades of life, the most frequent risk factors for stroke are heart diseases; arterial diseases play a dominant role in the consecutive three decades.
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Affiliation(s)
- Anetta Lasek-Bal
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
| | - Ilona Kopyta
- b Department of Child Neurology , Upper-Silesian Child's Health Center, Medical University of Silesia , Katowice , Poland
| | - Aldona Warsz-Wianecka
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
| | - Przemysław Puz
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
| | - Beata Łabuz-Roszak
- c Faculty of Public Health, Department of Basic Medical Sciences , Medical University of Silesia , Katowice , Poland
| | - Katarzyna Zaręba
- a Department of Neurology, School of Health Sciences , Medical University of Silesia , Katowice , Poland
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Brainin M, Feigin V, Martins S, Matz K, Roy J, Sandercock P, Teuschl Y, Tuomilehto J, Wiseman A. Cut stroke in half: Polypill for primary prevention in stroke. Int J Stroke 2018; 13:633-647. [PMID: 29461155 DOI: 10.1177/1747493018761190] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review summarizes the potential for polypill therapies for stroke prevention. While a number of studies applying different approaches regarding polypill have been performed, none of them has had a focus on stroke as the main outcome. A combination pill containing drugs such as statins, diuretics, and other antihypertensives is currently available in various formats. Estimates focusing mostly on primary prevention show that using such a combination drug a reduction in the 5-year stroke incidence by 50% can be achieved - especially in low- and middle-income countries with a high prevalence of risk factors even among people at young ages. A combination of a large supporting population-wide program with a registry-based quality control is the most likely perspective and can be achieved within a reasonable time frame and potentially have significant influence in young stroke populations.
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Affiliation(s)
- Michael Brainin
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- 2 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Sheila Martins
- 3 Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Karl Matz
- 4 Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - Jayanta Roy
- 5 AMRI Institute of Neurosciences, Kolkata, India
| | - Peter Sandercock
- 6 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yvonne Teuschl
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Jaakko Tuomilehto
- 7 Dasman Diabetes Institute, Kuwait City, Kuwait.,8 Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,9 Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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18
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Torrealba-Acosta G, Carazo-Céspedes K, Chiou SH, O'Brien AT, Fernández-Morales H. Epidemiology of Stroke in Costa Rica: A 7-Year Hospital-Based Acute Stroke Registry of 1319 Consecutive Patients. J Stroke Cerebrovasc Dis 2017; 27:1143-1152. [PMID: 29284569 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Limited data on stroke exist for Costa Rica. Therefore, we created a stroke registry out of patients with stroke seen in the Acute Stroke Unit of the Hospital Calderon Guardia. METHODS We analyzed 1319 patients enrolled over a 7-year period, which incorporated demographic, clinical, laboratory, and neuroimaging data. RESULTS The mean age of patients with stroke was 68.0 ± 15.5 years. Seven hundred twenty-five were men and the age range was 13-104 years. The most prevalent risk factors were hypertension (78.8%), dyslipidemia (36.3%), and diabetes (31.9%). Fifteen percent had atrial fibrillation and 24.7% had a previous stroke or transient ischemic attack. Prevalence of hypertension and atrial fibrillation increased with age; however, younger patients were more associated with thrombophilia. We documented 962 (72.9%) ischemic and 270 (20.5%) hemorrhagic strokes. Of the ischemic strokes, 174 (18.1%) were considered secondary to large-artery atherothrombosis, 175 (18.2%) were due to cardiac embolism, 19 (2.0%) were due to lacunar infarcts, and 25 (2.6%) were due to other determined causes. Five hundred sixty-nine (59.1%) remained undetermined. Atherothrombotic strokes were mostly associated with dyslipidemia, diabetes, metabolic syndrome, and obesity, whereas lacunar infarcts were associated with hypertension, smoking, sedentary lifestyle, and previous stroke or transient ischemic attack. Of our patients, 69.9% scored between 0 and 9 in the initial National Institutes of Health Stroke Scale (NIHSS). CONCLUSIONS We found differences in sociodemographic features, risk factors, and stroke severity among stroke subtypes. Risk factor prevalence was similar to other registries involving Hispanic populations.
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Affiliation(s)
- Gabriel Torrealba-Acosta
- Division of Neurology, Department of Internal Medicine, Hospital Rafael Ángel Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica; Neurosciences Research Center, University of Costa Rica, San José, Costa Rica.
| | - Kenneth Carazo-Céspedes
- Division of Neurology, Department of Internal Medicine, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Sy Han Chiou
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, Texas
| | | | - Huberth Fernández-Morales
- Division of Neurology, Department of Internal Medicine, Hospital Rafael Ángel Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica
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Ahmadi-Eslamloo H, Moosavi SMS, Dehghani GA. Cerebral Ischemia-Reperfusion Injuries in Vanadyl-Treated Diabetic Rats. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:544-552. [PMID: 29184262 PMCID: PMC5684375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ischemic stroke recovery is poor in diabetic mellitus (DM). Vanadium compounds (vanadium) relieve DM signs, but their influences on cerebral ischemia/reperfusion injury (I/RI) are inconclusive. Herein, the intensity of I/RI was inspected in vanadium-treated DM rats. METHODS Rats made diabetic with a single intravenous dose of streptozocin (39 mg/kg). Normal and DM rats used water or vanadyl solution for 45 days. Under isoflurane anesthesia, right middle cerebral artery occlusion was performed for 60 minutes and 12 hours reperfusion. Ischemic rats were divided into untreated-control normal (ICN) and diabetic (ICD), vanadium-treated normal (IVTN) and diabetic (IVTD) groups (n=14 each). After neurological deficit score (NDS) test, the rats were sacrificed and their brain removed and stained with triphenyltetrazolium chloride (TTC) to measure cerebral infarct volume (CIV, mm3) or Evans blue extravasation (EBE, μg/g wet-tissue). Data analysis was performed using one-way ANOVA and Tukey's test (SPSS software, version 21.0) and P values <0.05 were considered statistically significant. RESULTS Blood glucose (BG, mg/dL) was similar in ICN and IVTN, elevated in IVTD and ICD (245±6 vs. 344±2, P<0.001). The increased CIV in ICN and IVTN was similar (48±2 and 34±5), very high in ICD but lower in IVTD (249±37 vs. 110±16, P<0.001). EBE was absent in non-lesioned hemispheres, similarly increased in lesioned hemispheres of ICN and IVTN (14±1 and 13±1). EBE in IVTD was significantly lower than ICD (21±2 vs. 33±5, P=0.01). CONCLUSION I/RI was moderate in normoglycemia and did not change with vanadium. Hyperglycemia robustly intensified I/RI. Vanadium ameliorated hyperglycemia and reduced I/RI. Nonetheless, more investigations are required to link the mechanisms of vanadium on DM and stroke injuries.
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Affiliation(s)
| | | | - Gholam Abbas Dehghani
- Department of Physiology, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Gholam Abbas Dehghani, PhD; Department of Physiology, School of Medicine, Zand Blv., Shiraz, Iran Tel: +98 917171966 Fax: +98 71 32302026
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Singh V, Prabhakaran S, Chaturvedi S, Singhal A, Pandian J. An Examination of Stroke Risk and Burden in South Asians. J Stroke Cerebrovasc Dis 2017; 26:2145-2153. [PMID: 28579510 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/12/2017] [Accepted: 04/29/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND South Asians (India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan) are at a disproportionately higher risk of stroke and heart disease due to their cardiometabolic profile. Despite evidence for a strong association between diabetes and stroke, and growing stroke risk in this ethnic minority-notwithstanding reports of higher stroke mortality irrespective of country of residence-the explanation for the excess risk of stroke remains unknown. METHODS We have used extensive literature review, epidemiologic studies, morbidity and mortality records, and expert opinions to examine the burden of stroke among South Asians, and the risk factors identified thus far. RESULTS We summarize existing evidence and indicate gaps in current knowledge of stroke epidemiology among South Asian natives and immigrants. CONCLUSIONS This research focuses attention on a looming epidemic of stroke mainly due to modifiable risk factors, but also new determinants that might aggravate the effect of vascular risk factors in South Asians causing more disabling strokes and death.
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Affiliation(s)
- Vineeta Singh
- Department of Neurology, University of California San Francisco, San Francisco, California.
| | | | - Seemant Chaturvedi
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Aneesh Singhal
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
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21
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Lasek-Bal A, Gąsior Z. Cardiovascular diseases in patients 65 years and younger with non-cardiogenic stroke. Arch Med Sci 2016; 12:556-62. [PMID: 27279848 PMCID: PMC4889690 DOI: 10.5114/aoms.2016.59929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/13/2014] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Approximately 10-15% of patients with stroke are under 65 years of age. The aim of the study was to determine types of stroke In people below 65. We analysed the incidence and types of associated cardiovascular diseases in patients with non-cardiogenic stroke. MATERIAL AND METHODS In this prospective study patients (aged ≤ 65) with stroke underwent physical examination, computed tomography of the head, blood tests, electrocardiogram, echocardiography, and transcranial and carotid artery ultrasound. Classification of stroke was performed according to the ASCOD scale. Analysis considered the incidence of heart diseases in patients with non-cardiogenic stroke and the incidence of heart diseases recognised as a cause of cerebral embolism in patients with cardiogenic stroke. RESULTS The study included 611 patients with stroke at the age of 27-65 (mean: 57.2 ±6.7; M/F 380/231). Stroke of heterogeneous aetiology was observed in 321 patients, cardiogenic stroke in 78, and stroke caused by small vessel and carotid artery disease in 73 and 72 patients, respectively. The most common heart diseases in non-cardiogenic stroke patients included persistent foramen ovale, coronary heart disease and past myocardial infarction. The most common causes of cardiogenic embolism were cardiomyopathy, atrial fibrillation and interatrial septal defect. CONCLUSIONS Aetiologically heterogeneous stroke and cardiogenic stroke are the most commonly observed among young stroke patients. Cardiomyopathy and atrial fibrillation are the most common sources of cerebral embolism in young patients with cardiogenic stroke. Nearly 1/5 of patients with a non-cardiogenic stroke have congenital or acquired structural changes in the heart.
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Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- High School of Science, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, High School of Science, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
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Putaala J. Ischemic stroke in the young: Current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J 2016; 1:28-40. [PMID: 31008265 DOI: 10.1177/2396987316629860] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 12/25/2022] Open
Abstract
About one-fourth of ischemic strokes occur in working-aged individuals in the high-income countries, with worldwide increasing incidence in this age group from 1980s to present. Recent evidence suggests that traditional vascular risk factors are more prevalent than previously suggested in young adult stroke patients and they accumulate with age particularly in men. Accordingly, relatively high rates of atherosclerotic changes have been detected in these patients. The strength of association of vascular risk factors has gone poorly studied, however. Many young patients with ischemic stroke have, in turn, no traditional risk factors, while they may harbor other conditions with weak or uncertain association with the stroke alone. These individual conditions often represent a risk factor that may be strictly young-age specific, more prevalent in younger than older stroke patients (e.g. patent foramen ovale), or more prevalent among the young in the population. Despite high rates of vascular risk factors and atherosclerotic changes, these findings do not translate to higher frequencies of identified classical stroke mechanisms. In fact, cryptogenic causes are markedly common and even more frequent among the very young patients. Limited randomized trial evidence exists to support secondary prevention decision-making in patients, yet they face an increased risk of death and future vascular events for years to come-dependent on risk factor profile and cause of the stroke. This review provides an overview of recent data on epidemiology, risk factors, and their strength of association in ischemic stroke in the young. Furthermore, the relationship between with the risk factors and cardiovascular outcomes and key features on the evidence related to secondary prevention will be discussed.
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Affiliation(s)
- Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
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23
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Banerjee TK, Das SK. Fifty years of stroke researches in India. Ann Indian Acad Neurol 2016; 19:1-8. [PMID: 27011621 PMCID: PMC4782523 DOI: 10.4103/0972-2327.168631] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/01/2015] [Accepted: 06/15/2015] [Indexed: 11/30/2022] Open
Abstract
Currently, the stroke incidence in India is much higher than Western industrialized countries. Large vessel intracranial atherosclerosis is the commonest cause of ischemic stroke in India. The common risk factors, that is, hypertension, diabetes, smoking, and dyslipidemia are quite prevalent and inadequately controlled; mainly because of poor public awareness and inadequate infrastructure. Only a small number of ischemic stroke cases are able to have the benefit of thrombolytic therapy. Benefits from stem cell therapy in established stroke cases are under evaluation. Presently, prevention of stroke is the best option considering the Indian scenario through control and/or avoiding risk factors of stroke. Interventional studies are an important need for this scenario.
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Affiliation(s)
- Tapas Kumar Banerjee
- Head of Department of Neurology, National Neuroscience Centre, Kolkata, West Bengal, India
| | - Shyamal Kumar Das
- Department of Neurology, Burdwan Medical College, Burdwan, West Bengal, India
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Jaffre A, Ruidavets JB, Nasr N, Guidolin B, Ferrieres J, Larrue V. Tobacco Use and Cryptogenic Stroke in Young Adults. J Stroke Cerebrovasc Dis 2015; 24:2694-700. [PMID: 26481958 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Cryptogenic stroke is the leading subtype of ischemic stroke in the young. We sought to evaluate the association between traditional cardiovascular risk factors and cryptogenic stroke by using a case-control study. METHODS Patients aged 18-54 years, consecutively treated for first-ever cryptogenic ischemic stroke in an academic stroke unit, were compared with subjects from the general population living in the same geographic area. Control subjects were matched for age and sex with patients. We further evaluated the association between significant risk factors and nonobstructive (<50% stenosis) carotid plaque and thrombus among patients with cryptogenic stroke. Odds ratios [OR] were calculated using logistic regression analysis. RESULTS A total of 155 patients with cryptogenic stroke (66.4% men, mean age 43.5 years [SD 8.4]) were included in the study. Cryptogenic stroke was associated with current tobacco use (42.6% in patients versus 23.9% in control subjects; OR = 2.38, 95% confidence interval [CI] 1.40-4.05, P = .002). Current tobacco use was associated with nonobstructive carotid plaque (OR = 6.22; 95% CI, 2.43-15.9; P = .001) and nonobstructive carotid thrombus (OR = 13.7; 95% CI, 1.42-132.7; P = .03) among the patients. CONCLUSION Our case-control study showed a strong link between current tobacco use and cryptogenic stroke in young adults.
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Affiliation(s)
- Aude Jaffre
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France.
| | - Jean Bernard Ruidavets
- Department of Epidemiology and INSERM U1027, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Nathalie Nasr
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Brigitte Guidolin
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Jean Ferrieres
- Department of Epidemiology and INSERM U1027, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
| | - Vincent Larrue
- Department of Neurology, Toulouse University Hospital, 31059 Toulouse Cedex 9, France
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Subha PP, Pillai Geethakumari SM, Athira M, Nujum ZT. Pattern and risk factors of stroke in the young among stroke patients admitted in medical college hospital, Thiruvananthapuram. Ann Indian Acad Neurol 2015; 18:20-3. [PMID: 25745305 PMCID: PMC4350208 DOI: 10.4103/0972-2327.144293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/13/2014] [Accepted: 07/22/2014] [Indexed: 11/29/2022] Open
Abstract
Background: Stroke in the young is particularly tragic because of its potential to create a long-term burden on the victims, their families, and the community. There had been relatively few studies on young stroke in Kerala's socio-economic setup, that too encapsulating the mentioned apparently relevant dimensions of stroke in the young. Objective: To study the prevalence, patterns and risk factors of young stroke. Settings and Design: A cross-sectional study with case control comparison at Government Medical College Hospital, Thiruvananthapuram, Kerala, India. Materials and and Methods: Total 100 stroke patients were identified over a period of 2 months, and data were collected on the basis of questionnaire developed for the purpose. Results: Of 100 stroke patients, 15 had stroke in the young, among which 9 (60%) had ishaemic stroke. Hypertension was the most common risk factor. Smoking, alcohol, atrial fibrillation, and hyperlipidemia were found to be more common in cases (young stroke) when compared with controls. Alcohol use and atrial fibrillation were significantly higher among young stroke patients. Physical inactivity was significantly lesser in those with stroke in the young than elderly. Atrial fibrillation emerged as an independent risk factor of stroke in the young with adjusted odds ratio of 6.18 (1.31-29.21). Conclusion: In all, 15% of total stroke occurred in young adults <50 years. The proportion of hemorrhagic stroke in young adults is higher than in elderly. Atrial fibrillation is identified as an independent risk factor of stroke in the young. Compared with stroke in elderly alcohol use, smoking, hyperlipidemia, and cardiac diseases, which are known risk factors, are higher in young stroke.
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Affiliation(s)
| | | | - Mohan Athira
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Zinia Thajudeen Nujum
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
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Kvetkovskaya AA, Evsev'eva ME, Martynov MY, Gusev EI. [Characteristics of risk factors in young and middle-aged patients with first hemispheric ischemic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:13-18. [PMID: 26978634 DOI: 10.17116/jnevro201511512213-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare risk factors of the first hemispheric ischemic stroke in young, middle and old age groups. MATERIAL AND METHODS One hundred and thirteen patients with first hemispheric ischemic stroke confirmed by CT/MRI were examined. The patients were divided into 2 groups: young and middle-aged (51 patients, 24 women, 27 men, mean age 49.8±5.2) and advanced-aged (62 patients, 30 women, 32 men, mean age 76.4±7.5). The frequency and duration of the following risk factors for ischemic stroke, including arterial hypertension, ischemic heart disease and arrhythmias, diabetes, smoking, family history of myocardial infarction and/or stroke, body mass index, acute emotional stress before the onset of the disease, were compared. Results of echocardiography, Holter and blood pressure monitoring, total cholesterol, low and high-density lipoproteins, triglycerides and blood glucose were analyzed. RESULTS In young and middle-aged patients, an increased variability of blood pressure, acute emotional stress before the onset of stroke, a family history of cardiovascular and/or cerebrovascular disease, a decreased level of high-density lipoproteins, silent myocardial ischemia on Holter monitoring, mitral and tricuspid valve prolapse, minor abnormalities of the heart were more frequent than in the advanced age group. CONCLUSION There are age-related differences in the spectrum and frequency of risk factors in patients with first hemispheric ischemic stroke. This fact should be taken into account in stroke prevention programs in various age groups.
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Affiliation(s)
| | | | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow
| | - E I Gusev
- Pirogov Russian National Research Medical University, Moscow
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Dash D, Bhashin A, Pandit AK, Tripathi M, Bhatia R, Prasad K, Padma MV. Risk factors and etiologies of ischemic strokes in young patients: a tertiary hospital study in north India. J Stroke 2014; 16:173-7. [PMID: 25328875 PMCID: PMC4200587 DOI: 10.5853/jos.2014.16.3.173] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Stroke in young adults has a special significance in developing countries, as it affects the most economically productive group of the society. We identified the risk factors and etiologies of young patients who suffered ischemic strokes and were admitted to a tertiary referral hospital in North India. Methods A retrospective review of case records from patients with ischemic stroke in the age range of 18-45 years was conducted from 2005 to 2010. Data regarding patients' clinical profiles, medical histories, diagnostic test results, and modified Rankin Scale scores at hospital discharge were examined. Stroke subtyping was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results Of the 2,634 patients admitted for ischemic stroke, 440 (16.7%) were in the 18-45 year age range and the majority (83.4%) were male. The most common risk factors were hypertension (34.4%) and dyslipidemia (26.5%). The most common subtype of stroke was undetermined (57%), followed by other determined causes (17.3%). Among the category of undetermined etiology, incomplete evaluation was the most common. Most of the patients demonstrated good functional outcomes. Conclusions Young adults account for 16.7% of all stroke patients in North India. Risk factors are relatively prevalent, and a high proportion of the patients are categorized under undetermined and other determined causes. The results highlight the needs for aggressive management of traditional risk factors and extensive patient work-ups to identify stroke etiology in India.
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Affiliation(s)
- Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Ashu Bhashin
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Awadh Kumar Pandit
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
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Risk factor profile by etiological subtype of ischemic stroke in the young. Clin Neurol Neurosurg 2014; 120:78-83. [DOI: 10.1016/j.clineuro.2014.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/11/2014] [Accepted: 02/19/2014] [Indexed: 12/29/2022]
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Hassan KM, Verma A, Prakash S, Chandran V, Kumar S, Banerji A. Prevalence and association of lifestyle factors with extracranial carotid atherosclerosis in non-cardioembolic anterior circulation strokes in adult males less than 50 years: One year cross-sectional study. Ann Indian Acad Neurol 2013; 16:516-20. [PMID: 24339570 PMCID: PMC3841591 DOI: 10.4103/0972-2327.120448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/21/2013] [Accepted: 06/23/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Data is scarce on prevalence of extracranial carotid atherosclerosis (ECA) in strokes <50 years and its association with lifestyle factors. OBJECTIVE Study role of (a) ECA in non-cardio-embolic anterior circulation young strokes, and (b) smoking and alcohol in ECA. MATERIALS AND METHODS Cardiovascular risk factors and evidence of ECA on carotid doppler ultrasound (CDUS) was evaluated in an one-year preliminary cross-sectional study of consecutive strokes between 20 years and 49 years. Females were excluded. RESULTS There were 46 male strokes (mean age 38.26 yrs), 17.39% had hypertension, 2.23% had coronary artery disease; none was diabetic. Tobacco users and alcohol consumers were 24/46 (52.17%) cases each. ECA was found in 14/46 (30.44%) cases. Seven of these 14 (50%) i.e., 7/46 cases (15.21%) had carotid occlusion, four had <50%, three had >70% stenosis. 'Smoking and smokeless tobacco use' was found in 71.42% (10/14) symptomatic carotid lesions compared to 43.75% (14/32) strokes without carotid lesions. Prevalence odds ratio for tobacco use and ECA was 3.21 (95% CI: 0.83-12.44) while that of alcohol and ECA was 1.33 (95% CI: 0.38-4.72). CONCLUSION Prevalence of ECA in strokes <50 years was high due to lifestyle factors which predispose to atherosclerosis at younger age.
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Affiliation(s)
- Kaukab M Hassan
- Department of Internal Medicine, Division of Neurology, West Bengal University of Health Sciences, Alipore, India
| | - Aditya Verma
- Department of General Medicine, Medical College and Hospital, Kolkata, India
| | - Sudeep Prakash
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vijai Chandran
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, Maharashtra, India
| | - Suman Kumar
- Department of Internal Medicine, Division of Hematology, West Bengal University of Health Sciences, Alipore, India
| | - Anup Banerji
- Department of Internal Medicine, Division of Cardiology, Command Hospital, West Bengal University of Health Sciences, Alipore, India
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Kulshrestha M, Vidyanand. An analysis of the risk factors and the outcomes of cerebrovascular diseases in northern India. J Clin Diagn Res 2013; 7:127-31. [PMID: 23450177 DOI: 10.7860/jcdr/2012/4918.2686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/13/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Stroke is a growing epidemic in the developing countries. The risk factors of stroke are the same as those of atherosclerosis, but the relative incidences of the various risk factors keep changing with time and cultural and environmental factors. So, a periodic analysis should be done. AIMS AND OBJECTIVE The generation of the data which pertained to the clinical profile of stroke in our institution by using the WHO Steps Stroke Manual, version 2 and to make note of the risk factors and the correlation of the outcome with the Glasgow's Coma Scale (GCS) at admission and with the Modified Rankin Scale (MRS) on the 28th day. MATERIAL AND METHODS A prospective study was conducted on 157 cases of stroke patients who were admitted to the Medicine Department of a tertiary care institute during June 2011 through June 2012. OBSERVATIONS Amongst the 157 cases (92 males and 65 females), 86 % were above 40 years of age and this was the most prevalent age group in the age range of 51-60 years. The risk factor analysis showed hypertension as the most prevalent risk factor, followed by diabetes cum hypertension. Hemiplegia/hemi paresis was the most common presentation, followed by aphasia. Radiological studies showed that ischaemic strokes were the most frequent ones, followed by haemorrhagic strokes (71 vs. 29 %). Amongst the ischaemic infarcts, the anterior circulation infarct was the most frequent one. The outcome was poor with haemorrhagic strokes and in those who were presented with a GCS of less than 3. The overall mortality was 22.29 %. A significant residual deficit (MRS >3) was seen in 49.7 % of the patients. CONCLUSIONS There is a need for prospective representative population based surveys viz. the WHO Stroke Steps 2 and 3.Public health measures are essential to enhance the awareness about the importance of knowing the risk factors. Hence, the message which has to be percolated to the masses is - stroke is a 'brain attack' that is preventable.
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O'Dell MW, Au J, Schwabe E, Batistick H, Christos PJ. A Comparison of Two Balance Measures to Predict Discharge Performance From Inpatient Stroke Rehabilitation. PM R 2013; 5:392-9. [DOI: 10.1016/j.pmrj.2013.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 01/23/2013] [Accepted: 02/03/2013] [Indexed: 11/26/2022]
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Yamamoto FI. Ischemic stroke in young adults: an overview of etiological aspects. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:462-6. [PMID: 22699545 DOI: 10.1590/s0004-282x2012000600014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/17/2012] [Indexed: 11/22/2022]
Abstract
Stroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS). On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.
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Affiliation(s)
- Fábio Iuji Yamamoto
- Division of Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Kulshreshtha A, Anderson LM, Goyal A, Keenan NL. Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010. Neuroepidemiology 2012; 38:123-9. [PMID: 22433930 DOI: 10.1159/000336230] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally 15 million people have an acute stroke every year and one third of them die secondary to stroke events. Most research on stroke prevention and treatment is done in developed countries, yet more than 85% of strokes occur in developing countries. In particular, stroke remains an underrecognized cause of death and disability in South Asia. METHODS We conducted a systematic review to identify reliable and comparable epidemiological evidence on stroke in South Asia from 1980 to 2010. Publications were screened for eligibility to identify only population-based stroke studies. RESULTS Of the 71 studies retrieved, only 6 studies from South Asia gave us acceptable estimates of the burden of stroke. Population-based studies from South Asia have stroke prevalence in the range of 45-471 per 100,000. The age-adjusted incidence rate varied from approximately 145 per 100,000 to 262 per 100,000. Rural parts of South Asia have a lower stroke prevalence compared with urban areas. CONCLUSIONS Our review highlights the paucity of research data in South Asia. This must be addressed in order to accurately determine the burden of stroke in South Asia, so that specific policy recommendations can be formulated to combat the stroke epidemic in this region.
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Phillips MCL, Leyden JM, Chong WK, Kleinig T, Czapran P, Lee A, Koblar SA, Jannes J. Ischaemic stroke among young people aged 15 to 50 years in Adelaide, South Australia. Med J Aust 2012; 195:610-4. [PMID: 22107013 DOI: 10.5694/mja11.10558] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report risk factors, aetiology and neuroimaging features among a large series of young Australian patients who were admitted to hospital for a first-ever occurrence of ischaemic stroke; to analyse the effect of age, sex and ethnicity on the presence of risk factors; and to compare Australian and overseas data. DESIGN, SETTING AND PATIENTS Retrospective evaluation of data for all patients aged from 15 to 50 years who were admitted to a public hospital in Adelaide, South Australia, from January 2006 to June 2010 with a primary diagnosis of ischaemic stroke. RESULTS Among 326 patients (184 males), the most frequent stroke risk factors overall were dyslipidaemia (187), smoking (161), hypertension (105) and obesity (92). Fifty-one patients used illicit drugs, mostly comprising marijuana and amphetamines. The most frequent stroke aetiologies overall were cardioembolism (85), arterial dissection (49), and small-vessel occlusion (31). Cardioembolism was highly prevalent among our study population compared with patients in other countries. Neuroimaging showed that more patients in our study had strokes that involved both vascular territories concurrently (9%) compared with patients in other countries. CONCLUSIONS Risk factors, aetiology and features of ischaemic stroke among young people in Adelaide differ significantly from published data for young patients around the world. Patients in Adelaide are more likely to be obese, to be misusing marijuana and amphetamines, to suffer a cardioembolic event and to have a stroke that concurrently affects both the anterior and posterior cerebral circulation.
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Kumar HH, Kalra B, Goyal N. A Study on Stroke and its Outcome in Young adults (15-45 Years) from coastal South India. Indian J Community Med 2011; 36:62-5. [PMID: 21687386 PMCID: PMC3104713 DOI: 10.4103/0970-0218.80798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 08/12/2010] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hn Harsha Kumar
- Department of Community Medicine, Kasturba Medical College, Mangalore, Karnataka State, India
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Spengos K, Vemmos K. Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 - the Athens young stroke registry. Eur J Neurol 2011; 17:1358-64. [PMID: 20482604 DOI: 10.1111/j.1468-1331.2010.03065.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Data regarding stroke in young adults from Greece is scarce. We aimed to evaluate risk factors, etiology, and outcome in a hospital-based prospective observational study. METHODS Data from a series of 253 first-ever ischemic stroke patients aged 15-45 were collected over 10 years. Stroke etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment criteria. Comparisons were done between groups stratified by gender and age. The probability of death or composite vascular events during follow-up was estimated by the Kaplan-Meier method. We used Multivariate Cox proportional hazard analyses to determine the effect of different factors on mortality and occurrence of composite cardiovascular events. RESULTS Although male patients predominate in our cohort (ratio 1.3:1), females outnumber males significantly at ages under 30. Smoking (59.3%) and dyslipidemia (41.1%) were the most frequent risk factors. Small vessel disease was identified as cause of stroke in 17.4%, whereas cardioembolism caused 13.4% of all strokes. No definite etiology was found in 33.6%, whereas other causes of stroke, including dissection (6.7%), were documented in 26.5%. The probability of 10-year survival was 86.3% (95%CI: 79.1-93.6). The corresponding probability of composite vascular events was 30.4% (95%CI: 19.6-41.2). Stroke severity and heart failure were the main predictors of mortality. At the end of the follow-up period, most patients (92.7% of survivors) were independent. CONCLUSION There are gender- and age-related differences regarding risk factors and causes of ischemic stroke in young patients. Survival and long-term outcome is generally favorable.
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Affiliation(s)
- K Spengos
- First Department of Neurology, University of Athens Medical School, Athens, Greece.
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Tripathi M, Vibha D. Stroke in young in India. Stroke Res Treat 2010; 2011:368629. [PMID: 21234342 PMCID: PMC3017944 DOI: 10.4061/2011/368629] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/10/2010] [Indexed: 01/13/2023] Open
Abstract
Stroke in young has special significance in developing countries. This is so because some etiologies like cardioembolic infections are more common than in developed countries, and the affection of economically productive group adds further to the overall disease burden. The paper discusses the burden of stroke in young and its implications in a developing country like India along with an approach to identifying different causes that are known to occur in this age group.
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Affiliation(s)
- Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Association of the functional KL-VS variant of Klotho gene with early-onset ischemic stroke. Biochem Biophys Res Commun 2010; 403:412-6. [DOI: 10.1016/j.bbrc.2010.11.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 01/05/2023]
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Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol 2010; 9:1085-96. [DOI: 10.1016/s1474-4422(10)70251-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Leonards C, Ebinger M, Batluk J, Malzahn U, Heuschmann P, Endres M. The role of fasting versus non-fasting triglycerides in ischemic stroke: a systematic review. Front Neurol 2010; 1:133. [PMID: 21188262 PMCID: PMC3008919 DOI: 10.3389/fneur.2010.000133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 09/15/2010] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To synthesize results from pertinent studies and determine if fasting and/or non-fasting triglycerides are a risk factor for ischemic stroke. METHOD We performed two independent systematic literature searches using the PubMed and ScienceDirect databases to identify studies examining the relationship between fasting and non-fasting triglyceride concentrations and ischemic stroke risk. A meta-analysis was performed using ischemic stroke as a primary endpoint. RESULTS Twenty-five reports were identified, including 13 prospective cohort and 12 case-control studies. Baseline characteristics, study samples, methods, and primary outcomes varied. Of 13 prospective cohort studies, nine assessed triglyceride concentrations in the fasting state. Seven of these identified triglycerides as an independent risk factor for ischemic stroke risk (n = 1624 ischemic cases). Three prospective cohort studies identified a positive association between elevated non-fasting triglyceride concentrations and ischemic stroke risk (n = 2050 ischemic cases). One prospective cohort study that compared fasting and non-fasting triglycerides identified only non-fasting triglycerides as an independent risk factor for ischemic stroke. Of 12 case-control studies identified, five identified a positive relationship between ischemic stroke risk and elevated fasting triglycerides (n = 838 cases). Seven case-control studies were included in the meta-analysis (n = 1996 ischemic stroke cases), revealing an odds ratio of 1.15 (95% CI, 1.08-1.21). CONCLUSIONS The available data are inconsistent. The relationship between triglyceride levels and ischemic stroke needs further investigation under standardized conditions. We recommend a standardized triglyceride tolerance test to further investigate the associations between fasting versus non-fasting triglyceride levels and ischemic stroke.
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Affiliation(s)
| | - Martin Ebinger
- Center for Stroke Research Berlin, Charité – UniversitätsmedizinBerlin, Germany
| | - Jana Batluk
- Center for Stroke Research Berlin, Charité – UniversitätsmedizinBerlin, Germany
| | - Uwe Malzahn
- Center for Stroke Research Berlin, Charité – UniversitätsmedizinBerlin, Germany
| | - Peter Heuschmann
- Center for Stroke Research Berlin, Charité – UniversitätsmedizinBerlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité – UniversitätsmedizinBerlin, Germany
- Klinik und Poliklinik für Neurologie, Charité – UniversitätsmedizinBerlin, Germany
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Asymmetric dimethylarginine as a risk marker for early-onset ischemic stroke in Indian population. Clin Chim Acta 2010; 412:139-42. [PMID: 20883678 DOI: 10.1016/j.cca.2010.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/14/2010] [Accepted: 09/20/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND Asymmetric dimethylarginine (ADMA), a circulating endogenous inhibitor of nitric oxide synthase, has been associated with the pathogenesis of atherosclerosis. The present study was initiated to investigate the role of ADMA as a biomarker of risk for early-onset ischemic stroke. METHODS Plasma ADMA levels were measured in 201 ischemic stroke patients aged between 15 and 50 years and 217, age and gender-matched healthy controls, by high performance liquid chromatography using pre-column derivatization with O-phthaldialdehyde. RESULTS Patients with ischemic stroke had significantly higher plasma ADMA compared with the controls (1.49 vs. 0.97 μmol/l, p < 0.001). After adjustment for vascular risk factors, increased ADMA was associated with stroke (OR=1.55, 95% CI 1.25-1.92, p < 0.001). Univariate analysis showed that ADMA was significantly associated with age, alcohol, smoking, hypertension, diabetes mellitus, low serum HDL-cholesterol and homocysteine. By multiple stepwise linear regression analysis, diabetes, HDL-cholesterol and homocysteine were found to be independent determinants of plasma ADMA. CONCLUSIONS Increased plasma ADMA is associated with increased risk for ischemic stroke in the young. Diabetes mellitus, HDL-cholesterol and homocysteine are independent predictors of elevation in plasma ADMA concentration.
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Maasz A, Melegh B. Three periods of one and a half decade of ischemic stroke susceptibility gene research: lessons we have learned. Genome Med 2010; 2:64. [PMID: 20831840 PMCID: PMC3092115 DOI: 10.1186/gm185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Candidate gene association studies, linkage studies and genome-wide association studies have highlighted the role of genetic factors in the development of ischemic stroke. This research started over a decade ago, and can be separated into three major periods of research. In the first wave classic susceptibility markers associated with other diseases (such as the Leiden mutation in Factor V and mutations in the prothrombin and 5,10-methylenetetrahydrofolate reductase (MTHFR) genes) were tested for their role in stroke. These first studies used just a couple of hundred samples or even less. The second and still ongoing period bridges the two other periods of research and has led to a rapid increase in the spectrum of functional variants of genes or genomic regions, discovered primarily in relation to other diseases, tested on larger stroke samples of clinically better stratified patients. Large numbers of these alleles were originally discovered by array-based genome-wide association studies. The third period of research involves the direct array screening of large samples; this approach represents significant progress for research in the field. Research into susceptibility genes for stroke has taught us that careful stratification of patients is critical, that susceptibility alleles are often shared between diseases, and that not all susceptibility factors that associate with clinical traits that are themselves risk factors for stroke (such as increase of triglycerides) necessarily represent susceptibility for stroke. Research so far has been mainly focused on large- and small-vessel associated stroke, and knowledge on other types of stroke, which represent much smaller population samples, is still very scarce. Although some susceptibility allele tests are on the palette of some direct-to-consumer companies, the clinical utility and clinical validity of these test results still do not support their use in clinical practice.
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Affiliation(s)
- Anita Maasz
- Department of Medical Genetics, University of Pecs, H-7624 Pecs, Szigeti 12, Hungary.
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Mishra NK, Khadilkar SV. Stroke program for India. Ann Indian Acad Neurol 2010; 13:28-32. [PMID: 20436743 PMCID: PMC2859584 DOI: 10.4103/0972-2327.61273] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 12/31/2009] [Accepted: 01/04/2010] [Indexed: 11/05/2022] Open
Abstract
India is silently witnessing a stroke epidemic. There is an urgent need to develop a national program towards "Fighting Stroke". This program should be specific to our national needs. In order to recommend on who should lead an Indian fight-stroke program, we examined the published opinions of stroke clinicians and the official documents on stroke care training abroad. We identified the resources that already exist in India and can be utilized to develop a national fight-stroke program. Through a review of published literature, we noted different opinions that exist on who would best manage stroke. We found that because stroke is a cardiovascular disorder of the central nervous system, its management requires a multi-disciplinary approach involving clinicians with background not limited to neurology. India has very few neurologists trained in stroke medicine and they cannot care for all stroke patients of the country. We propose a mechanism that would quickly put in place a stroke care model relevant in Indian context. We recommend for tapping the clinical expertise available from existing pool of non-neurologist physicians who can be trained and certified in stroke medicine (Strokology). We have discussed an approach towards developing a national network for training and research in Strokology hoping that our recommendations would initiate discussion amongst stroke academicians and motivate the national policy makers to quickly develop an "Indian Fight Stroke Program."
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Affiliation(s)
- Nishant K Mishra
- Acute Stroke Unit, Western Infirmary and Faculty of Medicine, Department of Medicine and Therapeutics, University of Glasgow, 44, Church Street, Glasgow, G11 6NT, Scotland
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Majumdar V, Nagaraja D, Karthik N, Christopher R. Association of Endothelial Nitric Oxide Synthase Gene Polymor-phisms with Early-Onset Ischemic Stroke in South Indians. J Atheroscler Thromb 2010; 17:45-53. [DOI: 10.5551/jat.1560] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Farooq MU, Majid A, Reeves MJ, Birbeck GL. The epidemiology of stroke in Pakistan: past, present, and future. Int J Stroke 2009; 4:381-9. [PMID: 19765127 DOI: 10.1111/j.1747-4949.2009.00327.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Stroke is a major public health problem in developing countries of South Asia. In this paper, we review the epidemiology of stroke in Pakistan. Most of the available data are based on hospital-centred case series addressing established stroke risk factors, stroke-related mortality and disability, functional status, and case fatality rates. There are limited population-based data regarding the prevalence of established stroke risk factors in the general population, and no epidemiologic studies have been conducted to specifically identify potential stroke risk factors unique to the region. The limited data that are available from Pakistan indicate that stroke epidemiology differs between Pakistan and Western populations - in Pakistan first stroke occurs at a younger age, particularly among women, and there is a higher proportion of haemorrhagic strokes. Besides the established stroke risk factors (e.g. hypertension, smoking, and diabetes) some potentially unique stroke risk factors related to life style and dietary habits such as huqqa smoking, use of dalda and desi ghee, and orally consumed forms of tobacco, may exist in Pakistan, and warrant further investigation. The shortage of trained stroke epidemiologists is a major limiting factor to the conduct of epidemiological stroke studies in Pakistan. Epidemiologic data are essential to guide health policy development aimed at decreasing the mortality and morbidity from stroke in Pakistan. To facilitate this process, medical professionals in Pakistan could participate in the World Health Organization's STEPwise approach to stroke surveillance, which provides a framework for data collection and comparison between and within populations.
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Affiliation(s)
- M U Farooq
- Department of Neurology and Ophthalmology, Division of Cerebrovascular Disorders, Michigan State University, East Lansing, MI 48824, USA
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Sridharan SE, Unnikrishnan J, Sukumaran S, Sylaja P, Nayak SD, Sarma PS, Radhakrishnan K. Incidence, Types, Risk Factors, and Outcome of Stroke in a Developing Country. Stroke 2009; 40:1212-8. [DOI: 10.1161/strokeaha.108.531293] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sapna E. Sridharan
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - J.P. Unnikrishnan
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sajith Sukumaran
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P.N. Sylaja
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - S. Dinesh Nayak
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. Sankara Sarma
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kurupath Radhakrishnan
- From the Department of Neurology and Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke. J Neurol 2008; 255:1503-7. [DOI: 10.1007/s00415-008-0949-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 02/26/2008] [Accepted: 03/26/2008] [Indexed: 10/21/2022]
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Apolipoprotein A5 gene C56G variant confers risk for the development of large-vessel associated ischemic stroke. J Neurol 2008; 255:649-54. [DOI: 10.1007/s00415-008-0768-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 09/18/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022]
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Leary MC, Caplan LR. Cardioembolic stroke: An update on etiology, diagnosis and management. Ann Indian Acad Neurol 2008; 11:S52-S63. [PMID: 35721445 PMCID: PMC9204115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/09/2007] [Accepted: 01/09/2008] [Indexed: 11/25/2022] Open
Abstract
Stroke and ischemic heart diseases are among the most common causes of death and disability throughout the world. Even more worrisome is the suggestion that stroke rates may further increase in certain developing nations. The purpose of this article is to review the particular subtype of stroke known as cardioembolic stroke. A cardioembolic stroke occurs when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue. The etiology, clinical manifestations, diagnosis and management of cardioembolic stroke are reviewed.
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Affiliation(s)
- Megan C. Leary
- Division of Stroke and Cerebrovascular Disease, Palmer 127, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Louis R. Caplan
- Division of Stroke and Cerebrovascular Disease, Palmer 127, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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