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Year : 2019 | Volume : 7 | Issue : 2 | Page : 59 - 61  


Original Articles
Clinical Profile, Risk Factors and Outcomes in Patients with Acute Stroke- A Prospective Observational study

Thirunadhar R1, Rajashekar G2*, Sanjay Kumar Venkatesh K3, ShanmugaRaju P4

1, 2 Associate Professor, Department of General Medicine, Assistant Professor, Department of Neurology, 4Professor, Department of Physical Medicine & Rehabilitation, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar-505001, Telangana, India.

*Corresponding Author:

Dr. Rajashekar G                                                                                                                 

E-mail: arang05@gmail.com                                                                                            

Abstract:

Background: Burden of disease in India (2005) had estimated that there had been an increase in number of stroke cases in India during the last one and a half decade by 17.05%, thus showing worrying upward trends of disease

Objective: To investigate the profile, risk factors, and clinical outcomes in patients with acute stroke.

Methods: The study design was prospective observational study was conducted including 65 patients aged more than 18 years admitted in medical wards from November 2017 to April 2018. Detailed clinical profile and investigations were done.

Results: Total 70 patients were included in this study. There were more male percent (36.17%) than females (63.83%). The age distribution between the Male and Female and association between the age and gender is found not significant at 5% level of Significance. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging..

Conclusion: In conclusion, recovery from acute stroke which found to be highly significant at 5% level of significance.

Keywords: Acute stroke, risk factors, physiotherapy, outcome,

INTRODUCTION: 

A stroke occurs when arteries which carries oxygen to the brain cells is either narrowed or clogged by a clot (ischemic) or bursts (hemorrhagic stroke). 1 Stroke is main cause of disability and mortality among the aging population, and about 87% of all cases are ischemic stroke while 15% are hemorrhagic stroke. 2

Burden of disease in India (2005) had estimated that there had been an increase in number of stroke cases in India during the last one and a half decade by 17.05%, thus showing worrying upward trends of disease. 3

In India, with more than 1 billion inhabitants, are undergoing remarkable economic and demographic changes in recent years resulting in a transition from poverty-related economic and nutritional deficiency diseases toward lifestyle –related cardiovascular and cerbrovascular diseases. 4, 5

The current study was conducted to describe clinical profile, risk factors and outcomes in acute stroke patients. 

METHODS:

A prospective observational analysis study was conducted including 100 patients admitted with acute stroke patients in medical wards form November 2017 to November 2018 in the department of Medicine, Chalmeda AnandRao Institute of Medical Sciences, Karimnagar. 

Inclusion Criteria:

  1. Aged more than 18 years
  2. Diagnosed with acute stroke patients and confirmed by CT scan or MRI scan were included.
  3. Patients admitted within 24 hours after onset of symptoms.
  4. Informed and written consent form was obtained from each recruited patient. 

Exclusion Criteria:

  1. Patient diagnosis of any infective, genetic and inflammatory disease.
  2. Chronic kidney disease.
  3. Post surgery of CVA patients
  4. Epilepsy and head injury patients.

All patients are were assessed clinically, a detailed history, and demographic variables including age, sex, side of weakness, history of TIA, hypertension, diabetes mellitus, cardiac disease, previous stroke, smoking, alcohol use and family history.

Routine hematological and biochemical test were done including HB, total leukocyte count, ESR, random blood sugar, serum creatinine, blood urea, serum electrolytes and lipid profile. Electrocardiogram (ECG), Echocardiography ad carried Doppler study were done in all patients. Brain imaging including computed tomography (CT scan) and magnetic resonance imaging (MRI scan) at admission. Medical interventions and regular physiotherapy treatments were done in all acute stroke patients. 

Ethical Approval

This study was reviewed and approved by the Institute ethics committee, CAIMS, Karimnagar and a written informed consent was taken from all the participants. 

Statistical analysis

The recorded data were statistically analyzed for the percentage and mean and standard deviation of all variables.  A students t-test and chi-square (χ2) were used as appropriate. p <0.05 was considered significant. 

RESULTS:

Graph 1: Incidence of Infarct & Hemorrhage with reference to sex

In total sample size 65 patients were participated in this study. Age was 30 years or above and 63.83% of participants were males. Out of 65 patients ischemic 88.30%, hemorrhagic 9.57% and lacuner stroke 2.13% were observed in Table 3. Total 7 (7.45%) patients only were reported in young patients.

Table 1: Age and Sex distribution in Stroke Patients

Age (years)

Male

Female

Total

%

P value

30-40

4

3

7

7.4

0.515

41-50

9

2

11

11.7

51-60

18

9

27

28.7

61-70

20

16

36

38.3

71-80

9

4

13

13.8

Total

60 (63.8%)

34 (36.2%)

91

100

 

Table 1 shows the age distribution between the Male and Female and association between the age and gender is found not significant at 5% level of Significance. 

Table 2 : Risk Factors among study subjects

Risk factors

Number

%

HPT

80

85.1

DM

25

26.6

HCL

20

21.3

Smoking

30

31.9

Alcohol

44

46.8

MI

8

8.5

Family history of smoking

1

1.1

Table 3: Infarct & Hemorrhage with reference to sex

Type of stroke

female

Male

Total

%

P value

hemorrhage

5 (55.56%)

4 (4.44%)

9

9.57

0.20

Ischemic

27(32.53%)

56 (67.47%)

83

88.30

 

Lacunar stroke

2 (100%)

0 (0.0%)

2

2.13

 

Total

34(36.17%)

60(63.83%)

94

100

 

Above table which is showing association between type of stroke and gender found to be non-significant at 5% level of significance

Table 4: Patients of stroke who died

Type of Stroke

No. of Cases

Percentage

Hemorrhage

2

2.13

Ischemic

2

2.13

Lacunar Stroke

0

0.00

Total

4

4.26

Table 5: Clinical features in study group

Clinical features

Hemorrhage

Ischemic stroke

Lacunar stroke

N

%

N

%

N

%

Rt

0

0.00

42

44.68

2

2.13

Lt

1

1.06

0

0.00

0

0.00

Paralysis

9

9.57

83

88.30

2

2.13

Headache

3

3.19

53

56.38

0

0.00

Coma

4

4.26

5

5.32

0

0.00

Dysarthria

6

6.38

34

36.17

0

0.00

Aphasia

8

8.51

73

77.66

2

2.13

Swallowing Difficult

4

4.26

28

29.79

0

0.00

Incontinence

7

7.45

59

62.77

2

2.13

Gait Problem

8

8.51

81

86.17

2

2.13

Table 6: Recovery in study group

Type of stroke

Yes

No

P value

N

%

N

%

 

Hemorrhage

4

4.26

5

5.32

Ischemic

77

81.91

6

6.38

Lacumar
 Stroke

2

2.3

0

0

Total

83

88.3

11

11.7

 

Table 6 showing the information of recovery from acute stroke which found to be highly significant at 5% level of significance

DISCUSSION:

To our knowledge, the present study was prospective observational analysis study, to evaluate the clinical profile, risk factors and outcomes of stroke patients. Present study showed that the patients average age of was elderly than younger stroke patients. In almost all age groups, stroke is more common in men than in women. Male predominance was observed to be highest in Asia with a lower male/female ratio has been noted in European 3, 4, 5 and North American studies. 6-8

We observed our study, the most of patients high alcohol user 46.81% and smoking 31.17% in particularly in men and high rate of hypertension 85.11%, diabetes mellitus 26.60% and dyslipidemia (21.28%), which probably confer a higher risk. Only 8.51% had known atrial fibrillation in this study. The overall mortality rate at hospital discharge was 4.26 % (table 4).

Stroke is the leading cause of death and disability in developing countries such as India. Residual disabilities negatively affect the stroke survivors functional independence and quality of life. 9, 10 Physical rehabilitation is necessary for them to regain the lost skills, to relearn task, and to be independent again.

Even in developed countries with advanced health care systems, 60% of the people who suffer stroke die, become permanently disabled, or become dependent functionally. There are two major classes of functional impairment that can occur following stroke-hemi paresis in the upper limb and difficulty with independent walking.

All stroke patients were treated regular physiotherapy within 2 weeks of duration. In present study showed recovery outcomes were significantly improvement at hospital discharge. (Table 6) In Hemorrhagic stroke, there was no significant difference in recovery outcome.

This study was limited by the small population size compared to other studies that have used larger population. Need for further study required in this study. 

CONCLUSION:

Our study showed that in patients with ischemic and lacunar stroke recovery outcomes were significantly improvement compared with hemorrhagic stroke. 

REFERENCES:

  1. Reddy KS. Cardiovascular diseases in non-western countries. N Engl J Med. 2004; 350:2438-2440.
  2. Dalal PM. Burden of stroke: Indian perspective. Int J Stroke. 2006; 1:164-166.
  3. Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first ever ischemic stroke: The Helsinki Young Stroke Registry Stroke. 2009; 40:1195-203.
  4. Spengos K, Vemmos K. Risk factors, etiology and outcome of first-ever ischemic stroke in young adults aged 15-45: The Athens Young Stroke Registry. Eur J Neurology. 2010; 17:1358-64.
  5. Naess H, Nyland HI, Thomassen L. et al. Incidence and short term outcome of cereberal infarction in young adults in Western Norway. Stroke. 2002; 33:2105-8.
  6. Varona JF, Guerra JM, Bermejo F, et al. Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol. 2007; 57:212-8.
  7. Qureshi AI, Safdar K, Patel M, et al. Stroke in young black patients: risk factors, subtypes, and prognosis. Stroke 1995; 26:1995-8.
  8. Ruijun Ji, Schwamm LH, Pervez MA, et al. Ischemic stroke and transient ischemic attack in young adults. Risk factors, diagnostic yield, neuro imaging and thrombolysis. JAMA Neurol 2013; 70(1):51-7.
  9. Dhandapani S, Aggarwal A, Srinivasan A, Meena R, Gaudihalli S, Singh H, et al. Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation? Surg Neurol Int. 2015; 6:S54.
  10. Staines WR, Mellory WE, Brooks D. Functional Impairment Following Stroke: Implication for Rehabilitation. Toronto Rehabilitation Institute. Available from: http://www.ncbi.nml.nih.gov




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