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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
Stroke

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Stroke

  • 1. STROKE Dr Ubaid N P Community Medicine Pariyaram Medical College
  • 2. 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
  • 3. • 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.
  • 4. Aetiology A. Ischaemic stroke - Lacunar infarct - Carotid circulation obstruction - Vertebrobasilar obstruction B. Hemorrhagic stroke - Spontaneous intracerebral hemorrhage - Subarachnoid hemorrhage - Intra cranial aneurysm - Arteriovenous malformation
  • 5. • 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
  • 6. Risk factors • Hypertension • Cardiac abnormalities – LVH, Dilatation • Diabetes • Elevated blood lipids • Obesity • Smoking • Glucose intolerance • Oral contraceptives etc
  • 7. 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
  • 8. 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