Download STROKE - Department of Community Medicine ACME Pariyaram

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
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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