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Alnaami I, Alhazzani A, Alburaidi I, Alkhayri M, Dibssan H, Alqahtani MS, Alqahtani M, Alqahtani S, Shehata SF, Gaber A, Alqahtani SA. Demographic characteristics and types of stroke in Southwestern Saudi Arabia, and the potential demand of neuro endovascular specialists. ACTA ACUST UNITED AC 2021; 26:62-68. [PMID: 33530045 PMCID: PMC8015492 DOI: 10.17712/nsj.2021.1.20200104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify demographic characteristics, and types of stroke in Southwestern (Aseer) Region, Saudi Arabia. METHODS This study is a retrospective and hospital-based. The data of all stroke patients (n=562) admitted to the tertiary care hospital in the province, Aseer Central Hospital (ACH) within the period from January 2016 until December 2017 are included. RESULTS The mean ± SD of stoke patients' age was 62.6 ± 17.0 years. Male patients were more than female patients (62.6% and 37.4%, respectively). The majority (93.2%) were Saudi, while 91.5% had below university education and 6.4% were smokers. Interestingly, only 2% of patients had a family history of stroke, while 68.1% were diabetic, 80.4% were hypertensive, 91.6% had high serum cholesterol level, and 10.7% had history of transient ischemic attacks (TIA). Despite the lack of awareness, and leading to delay in reaching health care facility, 58.1% of stroke patients, were arriving to emergency department (ED) in less than 24 hours (potential endovascular therapeutic window). CONCLUSIONS In Aseer Region, Saudi Arabia, stroke affects mainly those who are older, less educated, diabetic, hypertensive, with hypercholesterolemia and previous history of TIA. Associated factors for stroke differ significantly according to their nationality.
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Affiliation(s)
- Ibrahim Alnaami
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Adel Alhazzani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Ibrahim Alburaidi
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mona Alkhayri
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Hani Dibssan
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mohammed S Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mohammed Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Saleh Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Shehata F Shehata
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Ashraf Gaber
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Saeed A Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
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Tsai LK, Lee IH, Chen YL, Chao TF, Chen YW, Po HL, Lien LM, Chu PH, Huang WC, Lin TH, Lin MT, Jeng JS, Hwang JJ. Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology. J Formos Med Assoc 2020; 120:93-106. [PMID: 32534996 DOI: 10.1016/j.jfma.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 01/10/2023] Open
Abstract
Cryptogenic stroke comprises about one-quarter of ischemic strokes with high recurrence rate; however, studies specifically investigating the features and treatment of this stroke subtype are rare. The concept of 'embolic stroke of undetermined source' (ESUS) may facilitate the development of a standardized approach to diagnose cryptogenic stroke and improve clinical trials. Since recent large randomized control trials failed to demonstrate a reduction in stroke recurrence with anticoagulants, anti-platelet agents remain the first-line treatment for ESUS patients. Nevertheless, patients with high risk of stroke recurrence (e.g., those with repeated embolic infarcts despite aspirin treatment) require a more extensive survey of stroke etiology, including cardiac imaging and prolonged cardiac rhythm monitoring. Anticoagulant treatments may still benefit some subgroups of high-risk ESUS patients, such as those with multiple infarcts at different arterial territories without aortic atheroma, the elderly, or patients with high CHA2D2-VASc or HOVAC scores, atrial cardiopathy or patent foramen ovale. Several important ESUS clinical trials are ongoing, and the results are anticipated. With rapid progress in our understanding of ESUS pathophysiology, new subcategorizations of ESUS and assignment of optimal treatments for each ESUS subgroup are expected in the near future.
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Affiliation(s)
- Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Wei Chen
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan
| | - Helen L Po
- Stroke Center and Department of Neurology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Tai Lin
- Division of Pediatric Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Juey-Jen Hwang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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