Stroke Patterns in Northeast Malaysia: A Hospital-Based Prospective Study

Abstract

All patients with a first-ever stroke admitted to the HUSM (Hospital Universiti Sains Malaysia) from 1997 to 1998 were included in this study. All risk factors were determined and analysed prospectively. There were 158 cases of stroke admitted during the study period. The majority of the patients were Malays (86.1%), with a male preponderance. The mean age (SD) of the patients with stroke was 59.3 (12.28) years. Hypertension was present in both cerebral infarct and intracerebral haemorrhage patients at almost the same rate (65.2 and 69.2%, respectively). The overall mortality was 37%, and most patients died in the 1st month after stroke (34%). We hope this study will highlight the problems associated with the presentation and management of stroke in Southeast Asia.

Spontaneous Intracerebral Hemorrhage in Northeast Malaysian Patients: A Four-Year Study

“…Similarly, Fauziah et al [28] reported that there were no patients with primary ICH in their study on hypercholesterolemia. Interestingly, in a study conducted in Hong Kong, the total cholesterol was not a risk factor at all and total triglyceride was a significant risk factor for strokes collectively but not for any specific subtype of stroke [35].…”

“…In a local epidemiology study of Northeast Malaysian stroke patients, hypertension was the most frequent risk factor noted in their patients, and was equally present in those with cerebral infarct and ICH, i.e. 65 and 69%, respectively [28]. The Stroke Data Bank [29] reported that 64% of ICH patients in 1983-1986 had a history of treated or untreated hypertension.…”

Hemorrhagic Stroke in the Tropics

“…22,24 In the rapidly industrializing countries of South and Southeast Asia (including China and India), there has been a rapid increase in both arterial hypertension prevalence and stroke mortality. [24][25][26] In South America and the Caribbean, the rate of death from cardiovascular disease related to arterial hypertension and other common risk factors has increased to the extent that the ratio of deaths from cardiovascular disease versus infectious disease is expected to triple by 2020 in that region. 2,27,28 Hemorrhagic stroke may affect a younger population compared with ischemic stroke.…”

Blood pressure in acute intracerebral haemorrhage

“…1 The worldwide incidence of ICH ranges from 10 to 20 cases per 100 000 population 3 and increases with age. Overall, ICH comprises about 15% of total acute stroke presentations, although there are racial and ethnic differences in incidence, which is reported to be higher in black people 3 and Asians, [4][5][6][7][8] occurring about 3.5 times more frequently in Taiwanese 5 and about twice as frequently in Japanese 6,7 compared with Caucasian populations. This is supported by results from 14 cohorts from the People's Republic of China and Japan reporting 45% of all strokes being of the haemorrhagic subtype.…”

“…However, it has been reported that primary ICH due to chronic hypertension or amyloid angiopathy accounted for 78-88% of ICH cases 3 and another study estimated that about 45-65% nonlobar ICH would be prevented if the effects of hypertension were eliminated. 10 Case fatality rate at 1 month is high for ICH, varying between 28 and 52%, 2,4,8,[11][12][13][14][15] with most deaths occurring within the first few days after the onset of symptoms. 16 Factors commonly reported to be associated with poor outcome include large haemorrhage size, 13,15,[17][18][19] reduced level of consciousness on admission, 14 low Glasgow Coma Scale score, 13,15,18,19 initial elevated BP, 12,14,17 intraventricular extension 15,18 and older age.…”