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Aurelius T, Maheshwari A, Ken-Dror G, Sharma SD, Amlani S, Gunathilagan G, Cohen DL, Rajkumar C, Maguire S, Ispoglou S, Balogun I, Parry A, Sekaran L, Syed H, Lawrence E, Singh R, Hassan A, Wharton C, Javaid K, Goorah N, Carr P, Sami EA, Sharma SR, Sylaja PN, Prasad K, Sharma P. Ischaemic stroke in South Asians: The BRAINS study. Eur J Neurol 2023; 30:353-361. [PMID: 36260058 PMCID: PMC10098949 DOI: 10.1111/ene.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Studies on stroke in South Asian populations are sparse. The aim of this study was to compare differences in age of onset of ischaemic stroke in South Asian patients living in the United Kingdom and South Asian patients living in India versus White British stroke patients. METHODS We studied the UK and Indian arms of the ongoing BRAINS study, an international prospective hospital-based study of South Asian stroke patients. The BRAINS study includes 4038 South Asian and White British patients with first-ever ischaemic stroke, recruited from sites in the United Kingdom and India. RESULTS Of the included patients, 1126 were South Asians living in India (ISA), while 1176 were British South Asian (BSA) and 1736 were White British (WB) UK residents. Patients in the ISA and BSA groups experienced stroke 19.5 years and 7.2 years earlier than their WB counterparts, respectively (mean [interquartile range] age: BSA 64.3 [22] years vs. ISA 52.0 [18] years vs. WB 71.5 [19] years; p < 0.001). Patients in the BSA group had higher rates of hypertension, diabetes mellitus and hypercholesterolaemia than those in the ISA and WB groups. After adjustment for traditional stroke risk factors, an earlier age of stroke onset of 18.9 years (p < 0.001) and 8.9 years (p < 0.001) was still observed in the ISA and BSA groups, respectively. In multivariable stepwise linear regression analysis, ethnicity accounted for 24.7% of the variance in early age onset. CONCLUSION Patients in the BSA and ISA groups experienced ischaemic stroke approximately 9 and 19 years earlier, respectively, than their WB counterparts. Ethnicity is an independent predictor of early age of stroke onset. Our study has considerable implications for public health policymakers in countries with sizable South Asian populations.
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Affiliation(s)
- Taylor Aurelius
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ankita Maheshwari
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sapna D Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sageet Amlani
- BARTS and the London NHS Trust/ Royal London Hospital, London, UK
| | | | | | - Chakravarthi Rajkumar
- Brighton and Sussex University Hospitals NHS Trust & Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Carr
- Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Shri Ram Sharma
- North Eastern Indira Gandhi Regional Institute for Health and Medical Sciences, Shillong, India
| | - Padmavathy N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kameshwar Prasad
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Ashford & St Peter's NHS Foundation Trust, Surrey, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
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任 国, 吴 雪, 李 颖, 李 婕, 孙 伟, 黄 一. [Susceptibility vessel sign in subacute stroke patients with large vessel occlusion]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:1133-1138. [PMID: 34916694 PMCID: PMC8695164 DOI: 10.19723/j.issn.1671-167x.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the presentation of susceptibility vessel sign (SVS) in subacute stroke patients with large vessel occlusion. METHODS We collected consecutive stroke patients who were admitted to Peking University First Hospital from December 2017 to August 2019 retrospectively. Those who had intracranial large vessel occlusion and received sensitivity weighted imaging (SWI) within 3 to 14 days after stroke onset were included in our analysis. The diagnosis of large vessel occlusion was based on magnetic resonance angiography (MRA), CT angiography (CTA) or digital subtraction angiography (DSA). The demographic information, clinical characteristics and imaging results were obtained from medical record. The occurrence rates of SVS sign were compared between stroke patients with cardioembolism (CE) and large artery atherosclerosis (LAA). In the sensitivity analysis, we performed a subgroup analysis in those patients who received SWI within 7 to 14 days after stroke onset. We also compared the occurrence rate of SVS sign between the patients with and without atrial fibrillation. RESULTS A total of 51 patients, 19 females and 32 males, with an average age of (63.04±11.23) years were analyzed in this study. Compared with LAA group, the patients in CE group were older and more likely to have an atrial fibrillation (P < 0.05). There were no significant differences between the CE group and LAA group in gender, hypertension, diabetes, coronary heart disease, hyperlipidemia, smoking, or National Institute of Health stroke scale(NIHSS) score at admission. SVS sign was found in 30 patients. Of whom, 3 were in CE group and 27 in LAA group. The occurrence rate of SVS sign was higher in the LAA group than in the CE group significantly (65.9% vs. 30.0%, P=0.039). The subgroup analysis showed that, in the patients who received SWI examination within 7 to 14 days after stroke onset, the differences between the two groups were still statistically significant (0 vs. 72.7%, P=0.006). Another sensitivity analysis showed that, the rate of SVS in the patients with atrial fibrillation was significantly lower than those patients without atrial fibrillation (25% vs. 65.1%, P=0.043). CONCLUSION In subacute stroke patients, the occurrence rate of SVS sign in CE group was lower than that of LAA group. The significance of SVS sign in the differentiation of stroke subtype needs further validation.
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Affiliation(s)
- 国勇 任
- 北京大学第一医院神经内科,北京 100034Department of Neurology, Peking University First Hospital, Beijing 100034, China
- 太原钢铁(集团)有限公司总医院神经内科,太原 030003Department of Neurology, General Hospital of Taiyuan Iron & Steel CO., LTD.(TISCO), Taiyuan 030003, China
| | - 雪梅 吴
- 太原钢铁(集团)有限公司总医院神经内科,太原 030003Department of Neurology, General Hospital of Taiyuan Iron & Steel CO., LTD.(TISCO), Taiyuan 030003, China
| | - 颖 李
- 北京大学第一医院神经内科,北京 100034Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - 婕妤 李
- 北京大学第一医院神经内科,北京 100034Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - 伟平 孙
- 北京大学第一医院神经内科,北京 100034Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - 一宁 黄
- 北京大学第一医院神经内科,北京 100034Department of Neurology, Peking University First Hospital, Beijing 100034, China
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Sinha RK, Singh A, Kishor A, Richa S, Kumar R, Kumar A. Evaluation of Oral Hygiene Status in Patients with Hemorrhagic and Ischemic Stroke. J Pharm Bioallied Sci 2021; 13:S233-S236. [PMID: 34447083 PMCID: PMC8375821 DOI: 10.4103/jpbs.jpbs_698_20] [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] [Received: 10/22/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Stroke can broadly be categorized into ischemic or hemorrhagic. Ischemic stroke accounts for 85% of cerebrovascular accidents (CVAs), whereas hemorrhagic stroke accounts for 15% of CVAs. Stroke is broadly associated with loss of sensation or unilateral paralysis of orofacial structures. Objectives: The present study was conducted to evaluate the prevalence of various oral features in patients with ischemic and hemorrhagic stroke. Materials and Methods: One hundred patients diagnosed with stroke admitted in the intensive care unit were included in the study. The evaluation of oral manifestations and their prevalence was done by a well-experienced oral medicine expert deputed in the dental department of the hospital. A single examiner performed all oral evaluations. Results: The mean and median for the age were 60.8 and 59. Sixty of 100 patients were male, whereas 38 were female. Forty patients had hemorrhagic stroke, whereas 60 had ischemic stroke. Senenty-eight patients of 100 had features of periodontitis, 90 of 100 patients presented with halitosis, 79 presented with caries, 83 patients had positive signs of tongue hypermobility, and 75 patients had dysphagia. Conclusion: Oral hygiene is the most neglected aspect during rehabilitation in stroke patients. It is critical for stroke patients to receive thorough oral care, as it can prevent other systemic ailments and potentially life-threatening complications like aspiration pneumonia.
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Affiliation(s)
| | - Anupama Singh
- Department of Dentistry, Darbhanga Medical College And Hospital, Darbhanga, Bihar, India
| | - Amit Kishor
- Primary Health Centre, Baniyapur, Saran, Bihar, India
| | - Shree Richa
- Department of Orthodontics and Dentofacial Orthopedics, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
| | - Rajiva Kumar
- Dental Medical Officer, Primary Health Centre, Health Department, Government of Bihar, Rajpur, Rohtas, Bihar, India
| | - Abhishek Kumar
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Patna, India
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MUTU CC, GHINCEA MI, SUCIU C, SUCIU V. A Four-Year Observational Study regarding the Characteristics and Causes of the Ischemic Stroke in Young Adults: one center study report. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Stroke is the second cause of mortality worldwide, after the ischemic coronary disease, and the first cause of long term-disability. Recent studies report that ischemic stroke (IS) in young patients is increasing in incidence, even though the overall stroke hospitalization rate is decreasing. Stroke in the young, working individuals significantly affects the quality of life (QoL) and also determines an important, negative economic impact by reducing the workforce. Material and method. The aim of this paper is to present the results of a 4-year observational, retrospective study on all patients between 18-49 years, who suffered from acute IS and were admitted and investigated in the Neurology Clinic of Sibiu and the CVASIC Research Center. Clinical evaluations, imaging investigations, and risk factor evaluations were performed on all patients in order to elucidate the etiology and organize according to the TOAST classification. Results and discussions. 114 patients with ischemic stroke were included in the study. 76% of the subjects fall into the 40-49 age class. In respect to the TOAST classification, most cases of IS were of UE (rural<urban), while the fewest cases of IS were represented by SAA in both populations. The most frequent vascular risk factors were hypertension, dyslipidemia, smoking and thrombophilia. Confirmed cervical arteries dissection caused 2/3 of the severe carotid stenosis and 45,5% of the carotid occlusions. Conclusions. Hypertension, dyslipidemia and smoking are the main risk factors for stroke in young patients. The most common TOAST stroke subtype was stroke of undetermined etiology, followed by stroke of other determined etiology (carotid artery dissection and thrombophilia).
Keywords: ischemic stroke, young patients, vascular risk factors, TOAST classification, disability,
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Affiliation(s)
- Cătălin Cosmin MUTU
- 1. “Lucian Blaga” University of Sibiu, Sibiu, Romania 2. Clinical County Emergency Hospital, CVASIC Research Center, Sibiu, Romania
| | | | - Corina SUCIU
- 3. Emergency County Hospital Cluj-Napoca, Romania
| | - Vlad SUCIU
- 4. Private Practice, Neurology, Cluj-Napoca, Romania
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