The Evolving Pattern and Outcome of Stroke at Moderate Altitude

Abstract

Background:The people residing in hills of this Sub-Himalayan region traditionally have a distinct lifestyle involving high level of physical activity. However, increased urbanization in the last two decades has led to changes in lifestyle of people. The present study was an endeavor to document changes in the pattern of stroke in people residing at moderate altitude.Aim:This study was aimed to study the evolving trends in clinical profile, risk factors, and outcome at 3 months in hospitalized patients of stroke in a Tertiary Care Hospital situated at moderate altitude.Setting and Design:This prospective, observational study was carried out in a Tertiary Care Hospital, situated at 2000 m mean sea level, from July 2014 to June 2015 in Sub-Himalayan region of India.Methods:The clinical features and risk factors profile of 235 patients of stroke consecutively admitted in hospital were analyzed, and findings were expressed in percentage. The profile was compared with a study conducted at this institute 15 years back. The outcome of patients at 3 months in terms of modified Rankin Scale >3 (mRS) and Barthel Index <60 (BI) was also studied.Results:The occurrence of stroke as a cause of hospitalization was decreasing. Ischemic stroke was noted in 74%, and 26% had hemorrhagic stroke (HS). There was male predominance (58%), but affliction of females with stroke increased from 34% to 42%. The altered sensorium (P = 0.00) and neurological weakness (P = 0.024) were significantly associated with poor outcome in stroke. The occurrence of hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among indoor patients of stroke in the last 15 years. Poor outcome of 203 patients at 3 months follow-up in terms of mRS >3 was 79 (IS-47, HS-32) but in term of BI, 63 (IS-32, HS-31) had poor outcome. Overall HS had poorer outcome. Age >70 years, female sex, altered sensorium, hypertension, and diabetes mellitus, were observed as poor prognostic factors, but the association was significant with advanced age, headache, and altered sensorium.Conclusion:The occurrence of stroke decreased among hospitalized patients. Hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among patients of stroke.

Factores de riesgo para primer episodio de accidente cerebro vascular encefálico a diferentes niveles de altitudrentes niveles de altitud

“…En Colombia, Machado -Alva et al reportan 64,9 +-10,9 años (19) y en Chile, Prat reporta una media de 66 años (20) . En su casuística Dhiman et al encontraron el promedio de edad de 62 años (21) . Castillo-Guerra et al, evaluando 98 pacientes con ACV isquémico 60 varones y 38 mujeres, reportan un promedio de edad de 70,5 +-11 años (22) .…”

“…Otro estudio evaluando 80 casos con ACV encontró una media de 64,92 +-11,58 años; el 73,75% presentó isquemia cerebral y el 26,25 % hemorragia intracerebral (24) . Dhiman et al, en su estudio realizado a 2000 m s.n.m., en 235 (100 %) pacientes reportan 173 (74 %) casos de ACV isquémico y 62 (26 %) casos de ACV hemorrágico (21). En nuestro estudio encontramos en altura ACV isquémico en 56,25 % y hemorrágico en 43,75 %.…”

“…La edad es un factor importante de aparición del ictus; después de los 55 años, por cada década que se incrementa la vida se duplica la incidencia del ictus; así mismo, los de mayor edad tienen una mayor mortalidad (23) . En su serie, Dhiman et al encontraron una mayor incidencia (28 %) entre los 61 y los 70 años de edad (21) . Según Pratt, el 93 % de los infartos cerebrales nuevos se producen en mayores de 45 años (20) .…”

“…Cantu-Brito et al, en su estudio incluyeron 1376 pacientes de 59 hospitales, entre enero del 2005 y junio del 2006, con edad promedio de 67,5 años; los principales factores de riesgo que encontraron fueron: hipertensión 64 %, obesidad 51% y diabetes 35% (26) . Dhiman et al (2018), evaluando 235 (100 %) pacientes reportaron que los factores de riesgo asociados al ACV fueron: hipertensión arterial (66 %), tabaquismo (36 %), diabetes (14 %), fibrilación auricular (11 %), enfermedad valvular reumática (5 %) (21) . Los factores de riesgo para DCV hemorrágico fueron la edad (OR = 1,97), ingesta de alcohol (OR = 3,36), hipertensión arterial (OR=3,68), sexo masculino (OR = 3,73), fumador (OR = 1,31) y diabetes (OR = 1,3) (27) .…”

Cerebral Artery Hypoplasia among Black Kenyans

“…Hypertension, cigarette smoking, and diabetes are the risk factors for the stroke. 5 Cerebrovascular accidents can be prevented by taking aspirin prophylaxis and lifestyle modification, like routine exercises. However, few things are genetically determined that persist and progress into the adult life.…”