Clinical and Radiological Profile of Cerebrovascular Disease in Polycythemia: Analysis of Neurologic Manifestations from a Tertiary Center in South India

PURPOSE

Patients with polycythemia, either primary or secondary, are at elevated risk for thrombotic complications, including stroke. We aimed to investigate the clinical and radiological characteristics of cerebrovascular disease (CVD) in polycythemia, and describe other neurologic manifestations.

METHODOLOGY

We conducted a cross-sectional study of patients diagnosed with polycythemia between 2014 and 2019 at a tertiary care center and collected relevant medical data with a special focus on cerebrovascular disease and neurologic manifestations. We performed descriptive and inferential analyses. We have also described and analyzed the available neuroimaging features.

RESULTS

We analyzed data from 56 patients. 20 patients (35.7%) had ischemic stroke. The incidence of CVD was higher in those with primary polycythemia (43%) than in those with secondary polycythemia (8%). The most common subtype of stroke was large vessel disease, and the most common arterial territory was the anterior circulation. There was no statistically significant difference in the hematocrit level between those with or without CVD. Neuroimaging revealed multiple large vessel intracranial stenoses on MR Angiography, and hyperdense vessels on plain CT. Other neurologic manifestations included headache, seizures, dizziness, visual symptoms and papilledema, and these were significantly more common in primary polycythemia.

CONCLUSIONS

CVD is common in patients with polycythemia. The most common type observed was large vessel occlusion, predominantly in the anterior circulation. In stroke patients, multiple vessel stenosis and hyperdense vessels may be clues to polycythemia.

Stroke Awareness among Elderly Hypertensives in a Rural Area of Bangalore District, India

OBJECTIVES

India faces a high and growing burden of hypertension, which is an important cerebrovascular risk factor, especially in elderly persons. Poor awareness contributes to delays in seeking health care, which is undesirable given the emergent nature of stroke. Literature regarding awareness in this subgroup of the population is scarce. Our objective was to assess awareness regarding cerebrovascular disease among elderly persons with hypertension residing in a rural area of Bangalore district, and estimate their individual risk of stroke.

MATERIAL & METHODS

We randomly selected 144 elderly hypertensives residing in a rural area in Bangalore district from a list of known hypertensives maintained as part of a population-based senior citizen health service. We developed an open-ended, face-validated questionnaire, which was administered following informed consent, to assess stroke awareness. We defined good awareness as knowing at least one risk factor, one warning sign, and having the knowledge that stroke requires immediate treatment. Univariate and multivariate analyses were performed to assess factors associated with good or poor awareness.

RESULTS

40% of the study population had not heard of the term 'stroke'. Only 22% could identify the brain as the organ affected. 51% could name at least one symptom. 45% of males and 24% of females believed that their hypertension predisposed them to stroke. 56% could not name a single risk factor. Only 37% of the males and 18% of the females had good overall awareness. Female gender and low literacy were associated with poor overall awareness, while being gainfully employed, a history of alcohol use and doing higher levels of exercise were associated with greater awareness on univariate analysis. None of these factors were statistically significantly related to stroke awareness on multivariate analysis.

CONCLUSIONS

Awareness of different aspects of stroke was very poor, highlighting the need for stroke education at all levels of care.