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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