Ischemic stroke in Morocco: a systematic review

Abstract

BackgroundThe aim of this systematic review is to determine the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.MethodsThe present work is a systematic review that was conducted according to the recommendations of the “Preferred reporting items for systematic reviews and meta-analysis”. We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the time frame 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206).These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10,172 in Acute Stroke Treatment, prehospital delay average and its influential factors, thrombolyzed patients’ proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco.ResultsTwenty-nine (n = 29) studies were selected. The average age ranged from 49 ± 15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by the prementioned studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 h. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies, which were conducted in hospital environment, have a reduced sample size and no confidence interval.ConclusionsIschemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. This indicates the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco.

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco

“…This lack of knowledge of the warning signs of stroke potentially impacts on the early use of specialized hospital centers for possible management of stroke patients. This finding was missed in a recent Moroccan systematic review study [6]. To address this concern, the High Authority of Health in France recommended that the treating physician inform patients at risk (vascular history, high blood pressure, diabetes, arteriopathy of the lower limbs, and so on), as well as their entourage, about the main signs of stroke to contribute to rapid access to neurovascular units [27].…”

“…Stroke incidence and mortality have increased in the countries of the Middle East and North Africa over the past decade, and projections indicate that stroke-related deaths will approximately double by 2030 in the same region [3,4]. Despite the rapid evolution of the generalization of intravenous thrombolysis in recent years in the countries of the Middle East and North Africa [5], the average symptom onset to arrival at a stroke center or emergency department (onset-to-door time [ODT]) of patients with ischemic stroke in Morocco remains very long, possibly resulting from a lack of knowledge, particularly of the first warning signs of an ischemic stroke, according to a recent systematic review [6].…”

Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys

“…The high performance of Morocco, on the other hand, was not mirrored in prior, yet limited literature. These studies have shown that while Morocco is already undergoing the epidemiological transition, the awareness of ischemic heart disease and CVD risk remained low in the population [52][53][54]. Hence, future research may yield valuable insights into the strengths and weaknesses of the Moroccan NCD care system.…”

Clinical Symptoms, Etiology and Prognosis of Acute Bilateral Posterior Circulation Cerebral Infarction

“…It was reported that men in the Arab world were most often victims of stroke (between 55.9% and 75%). 8 In the NEMC-PCR, the patients of PCCI comprised 256 men (63%) and 151 women (37%). 4 Two previous studies on bilateral cerebellar infarction showed that 85% and 64% of the patients were male, respectively.…”

“… 11 The reason of the large proportion of male patients may be hormonal factors including estrogen, which seems to have protective effects on both the vascular and cerebral systems. 8 …”