Arshad Naseem, Mahmood, Tassawar Hussain, Iqbal Ahmad Khan.
Clinical spectrum of Stroke in our adult population
Pak Armed Forces Med J Jun 2003;53(1):59-67.
Military Hospital Rawalpindi and Armed Forces Institute of Cardiology Rawalpindi

Despite recent advances in the management of cerebrovascular diseases, stroke still exacts a heavy toll in death and disability worldwide. This clinical survey carried out at Military Hospital Rawalpindi and Armed Forces Institute of Cardiology Rawalpindi was aimed at to determine etiology, to identify underlying risk factors and to assess early mortality (first 2wks) in our adult population suffering from first stroke. During study period of one year, a convenient sample of 104 patients (68 males and 36 females), aged 2085 years (irrespective of geographical or ethnic origin), with first stroke confirmed by CT scan brain, presenting within first 24 hours of onset of stroke was recruited and studied. Patients were divided into three groups according to their ages - Gp I (20-35yrs), Gp II (36-55yrs), and Gp III (56-85yrs). Patients with past H/O stroke and transient ischemic attacks (TIA`s), recent head injury and space occupying lesions were excluded. In each case detailed history along with thorough clinical especially neurological examination, and relevant investigations were carried out. CT scan brain was done in all patients while special investigations like anti-cardiolipin and anti-phospholipid antibodies, echocardiography, MRI brain, cerebral angiography and Doppler blood flow studies were done in selected cases. Patients in group II were the predominant sufferers (42.30%) while contributions from group I and group III were 30.76% and 26.92% respectively. Sixty nine (66.34%) patients suffered ischemic stroke, intracerebral hemorrhage was found in 29 (27.88%) cases while six patients (5.67%) had subarachnoid hemorrhage (SAH). The proportion of stroke related to pregnancy was 11.53%, dyslipidemia associated stroke was seen in 9.61%, stroke with anti phospholipid syndrome observed in 6.73%, while migraine associated stroke was notified in 3.84% cases, and stroke at high altitude was noticed in 3.84% cases. Smoking (38.46%), diabetes mellitus (31.73%) and hypertension (23.07%) were common risk factors. Hemorrhagic stroke was mostly associated with hypertension (27.88%) while ischemic stroke was commonly associated with diabetes and hypertension. Mortality in our study was 20.19%. This study demonstrates the diverse nature of stroke in our adult population, afflicting mostly the patients in their middle age, and a large percentage of them have multiple risk factors for stroke; calling for a need to identify and manage underlying risk factors more rigorously for primary prevention of this devastating illness.

Category: Neurology
Keywords: Stroke. Audit. Hypertension. Diabetes Mellitus. Lipids.

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