Stroke subtypes among Hispanics living in Guayaquil, Ecuador. Results from the Luis Vernaza Hospital Stroke Registry.

Abstract

Racial differences in stroke subtypes have been documented. Asians have a higher rate of cerebral hemorrhage than whites; however, there is little information about stroke subtypes among Hispanics. The purpose of this study was to determine the patterns of stroke subtypes in a population of Hispanics. Five hundred consecutive patients with a first stroke were included. Patients were collected from hospital wards, the emergency department, and the outpatient clinic to ensure inclusion of patients with a wide range of stroke severity. Computed tomography was available in all cases. Patients with pure subarachnoid hemorrhage were excluded. There were 313 (62.6%) patients with an infarct and 187 (37.4%) with a hemorrhage. Hypertensive arteriolopathy was the most common cause of both infarcts and hemorrhages. The carotid territory was involved in 70.6% of the 313 patients with infarcts, the vertebrobasilar territory in 17.9%, multiple territories in 6.7%, and a watershed area in 4.8%. Hemorrhages were most often lobar (36.4%), followed by putaminal (30.5%), brain stem (9.1%), cerebellar (8%), thalamic (8%), ventricular (5.3%), and caudate (2.7%). This hospital-based stroke registry suggests that stroke in Hispanics has a pattern different from that in whites but similar to that in Asians. Cerebral hemorrhages occur three times more frequently in Hispanics than in whites.

Role of a Stroke Data Bank in Evaluating Cerebral Infarction Subtypes: Patterns and Outcome of 1,776 Consecutive Patients from the Besançon Stroke Registry

“…The general characteristics and distribution of all infarct subtypes were comparable to those reported in other recent hospital-based studies on stroke [13, 14, 15, 16, 17, 18, 19]or on single-stroke cohorts [27, 28, 29, 30, 31, 32, 33, 34]: territorial infarcts in 79.1%, small deep infarcts in 16.9% and a border zone territory in 4.0%. Our findings also confirmed the general male preponderance in ischemic stroke, except when infarction involved the anterior circulation in older patients.…”

“…Early admission was the main characteristic in our patients; 85.4% of them were admitted the first day and 48.4% within the first 6 h. This point contrasts with most other registries in which patients are generally admitted later – up to the third week and sometimes beyond [11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 29, 30, 31, 32, 33, 34]. This high rate may also be explained by the severity of the infarction.…”

“…While the epidemiological aspects of ischemic stroke are well recognized in population-based stroke registries [1, 2, 3, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16], accurate subtypes of cerebal infarction, etiological mechanisms, precise clinical patterns and specific outcomes are only evaluated in hospital-based stroke registries [4, 17, 18, 19, 20, 29, 30, 31, 32, 33]. Yet, there are only a few registries which use a standardized evaluation to provide a large overview of the natural history of all hospitalized patients with brain infarctions [4, 34].…”

Quality of Ischemic Stroke Care in Emerging Countries

“…2 Most South American studies involving stroke populations are based on single hospital data and do not provide information regarding quality of care. 3,4 Knowledge of quality of stroke care is of critical importance to establish short-term prognosis and select better therapeutic goals. Whereas in the near future stroke prevalence will steadily increase and direct medical costs will continue to rise, 5 it is likely that hospitals' financial support will be based on performance.…”

Recurrent Primary Cerebral Hemorrhage

“…[2][3][4] A recently published study has also suggested a high frequency of cerebral hemorrhage in the Ecuadoran population. 5 The causes of ICH are multiple, 6 and the frequency of the various etiologies are age dependent. In people younger than 45 years the most common cause is arteriovenous malformation 7 ; in individuals older than 70 years it is amyloid angiopathy 8 ; and in the intermediate age groups hypertension is the primary cause.…”