STROKE Dr Ubaid N P Community Medicine Pariyaram Medical College

Introduction Acute severe manifestations of cerebrovascular disease WHO definition – “rapidly developed clinical signs of focal disturbance of cerebral function; lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin” TIA, subdural hemorrhage, tumors, poisoning or trauma are excluded

Caused by three morphological abnormalities – stenosis, occlusion or rupture of arteries Signs and symptoms are related to extend and site of the area involved and to the underlying causes Coma, hemiplegia, paraplegia, monoplegia, multiple paralysis, speech disturbances, nerve paresis, sensory impairement etc.

Aetiology A.Ischaemic stroke - Lacunar infarct - Carotid circulation obstruction - Vertebrobasilar obstruction B.Hemorrhagic stroke - Spontaneous intracerebral hemorrhage - Subarachnoid hemorrhage - Intra cranial aneurysm - Arteriovenous malformation

Cerebral thrombosis followed by hemorrhagic stroke is the most common form of stroke Worldwide 6.1 million deaths, 10.8% of all deaths (2008) Prevalence rate in India – 1.54/ 1000 population Highest risk of death in the first weeks after the event Survivors may have – no disability to mild, mod or severe disability Considerable spontaneous recovery can occur up to about 6 months Patients are at high risk for subsequent event of around 10% in first year 5% the year thereafter

Risk factors Hypertension Cardiac abnormalities – LVH, Dilatation Diabetes Elevated blood lipids Obesity Smoking Glucose intolerance Oral contraceptives etc

Host factors Age : can occur in any age, globally more in age >70 years, India – strokes in the young Sex: M > F Personal history : a/w diseases, esp. CVS disease and diabetes

Stroke Control Programme Community level effective measures for the prevention of stroke Control of arterial hypertension Early detection and treatment following TIA Management of other risk factors Control of complications Facilities for long term follow up of patients Reliable knowledge and extend of the problem in the community