The risk factors comparison of ischemic stroke and hemorrhagic stroke

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

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"EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity"

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2016.024227092016 ◽

2016 ◽

Vol 134 (6) ◽

pp. 543-554 ◽

Cited By ~ 2

Author(s):

Alessandra Carvalho Goulart ◽

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Local Community ◽

Hospital Setting ◽

Public Healthcare ◽

Stroke Mortality ◽

Community Based ◽

Mortality And Morbidity ◽

Risk Of Death

ABSTRACT CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.

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Sex difference in types and distribution of risk factors in ischemic and hemorrhagic stroke

International Journal of Stroke ◽

10.1177/1747493017724626 ◽

2017 ◽

Vol 13 (1) ◽

pp. 83-86 ◽

Cited By ~ 5

Author(s):

Alijan A Ahangar ◽

Payam Saadat ◽

Behzad Heidari ◽

Seyedeh T Taheri ◽

Shayan Alijanpour

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cardiovascular Disease ◽

Risk Factor ◽

Ischemic Stroke ◽

Sex Difference ◽

Cause Of Death ◽

Associated Factors ◽

Hemorrhagic Stroke ◽

Age Group

Background Stroke is the second leading cause of death worldwide and is associated with several risk factors with variable risk factor distribution by population. We report the types and frequency of the associated factors of stroke in north Iran. Methods Consecutive patients with stroke were recruited from 2014 to 2015. The two groups of ischemic and hemorrhagic stroke were compared with respect to age, sex, the prevalence, and distribution of the risk factors. Results Among 230 patients (84.3% ischemic stroke) with mean age of 61.2 years, hypertension (73%), diabetes mellitus (53%), cardiovascular disease (51%), and dyslipidemia (47%) were the most frequent risk factors. Hypertension was significantly more prevalent in males compared with females (88% vs. 60%, OR = 4.91, 95% CI: 2.48–9.71). Hypertension, smoking, and opioid consumption were associated with hemorrhagic stroke. Dyslipidemia was significantly higher in ischemic stroke (OR = 2.65, 95% CI: 1.21–5.8). Overall, 84.3% of stroke occurred in patients aged >50 years (92.8% of women vs. 74.5% of the men, OR = 4.43, 95% CI: 1.93–10.16, p = 0.001). Conclusion Stroke was more prevalent in females; hypertension was more prevalent in males. In the age group less than 50 years old, stroke is more prevalent in men.

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Circadian variation of stroke: a hospital based study

Medicine and Pharmacy Reports ◽

10.15386/cjmed-328 ◽

2014 ◽

Vol 87 (4) ◽

pp. 242-249 ◽

Cited By ~ 3

Author(s):

Dana Marieta Fodor ◽

Ioana Babiciu ◽

Lacramioara Perju-Dumbrava

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Demographic Data ◽

Circadian Variation ◽

Onset Time ◽

Consecutive Series ◽

Circadian Pattern ◽

Vascular Risk ◽

Stroke Subtypes

Aims and BackgroundThe circadian pattern of stroke occurrence variation has been recognized with certain differences between authors and stroke types. The underlying reason may be related to exogenous factors (cyclic physical activity, including sleep–awake cycles and assuming the up-right posture) and endogenous factors, with their diurnal variation (blood pressure, hemostatic balance, autonomic system activity). The aims of the present study are to investigate the existence of a circadian variation of stroke and the possible differences between stroke subtypes in the Cluj Napoca area.Materials and MethodThe stroke event data were acquired from the Patient Records of a consecutive series of 1083 patients admitted through the Emergency Room at Neurology Departments I and II of the District Hospital of Cluj Napoca, between 1 January 2012 and 31 December 2012. The classifiable onset time was assigned to one of four six-hour intervals: 00.01-06.00 (night), 06.01-12.00 (morning), 12.01-18.00 (afternoon) and 18.01-24.00 (evening). Demographic data and vascular risk factors were recorded.ResultsAll three stroke types (ischemic stroke, hemorrhagic stroke and subarachnoid hemorrhage) have shown a circadian variation regarding their occurrence, with the peak of incidence in the morning and the nadir during nighttime. This circadian pattern is independent by demographic factors and vascular risk factors.ConclusionOur study confirmed the circadian variation of onset occurrence for all stroke subtypes. Some triggering factors promote ischemic stroke and prevent hemorrhagic stroke. The diurnal pattern of variation with the higher incidence in the morning and the lower in the night may lead to chrono-therapeutic and preventive approach (chrono-therapy of the risk factors), which targets the period of the highest vulnerability after awaking.

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Gambaran Faktor Risiko dan Tipe Stroke pada Pasien Rawat Inap di Bagian Penyakit Dalam RSUD Kabupaten Solok Selatan Periode 1 Januari 2010 - 31 Juni 2012

Jurnal Kesehatan Andalas ◽

10.25077/jka.v2i2.119 ◽

2013 ◽

Vol 2 (2) ◽

pp. 57

Author(s):

Cintya Agreayu Dinata ◽

Yuliarni Safrita Safrita ◽

Susila Sastri

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Glucose Level ◽

High Glucose ◽

Hemorrhagic Stroke ◽

Secondary Data ◽

Modifiable Risk Factors ◽

Stroke Patients ◽

High Glucose Level

AbstrakStroke merupakan penyakit akibat gangguan peredaran darah otak yang dipengaruhi oleh banyak faktor risiko terdiri dari yang tidak dapat diubah berupa usia dan jenis kelamin dan yang dapat diubah seperti hipertensi, peningkatan kadar gula darah, dislipidemia, dan pekerjaan. Penelitian ini bertujuan untuk mengetahui distribusi tipe stroke dan faktor risiko yang berpengaruh pada pasien stroke rawat inap di RSUD Kabupaten Solok Selatan. Metode penelitian: Penelitian ini adalah penelitian deskriptif dengan menggunakan data skunder pasien stroke yang dirawat di RSUD Solok Selatan. Data yang diambil meliputi usia, jenis kelamin, tekanan darah, kadar gula darah, profil lipid saat pertama pasien masuk rumah sakit, dan pekerjaan. Sampel penelitian adalah seluruh pasien stroke yang pernah dirawat di Bagian Penyakit Dalam RSUD Kabupaten Solok Selatan pada periode 1 Januari 2010 – 31 Juni 2012 yang memenuhi kriteria inklusi. Hasil penelitian: Hasil penelitian menunjukkan proporsi stroke terbanyak adalah stroke ischemic (61,46%), perempuan (54,17%) yang berusia >50 tahun (81,25%) yang bekerja sebagai ibu rumah tangga (43,75%). Faktor risiko yang dapat diubah tertinggi adalah hipertensi (82,30%) diikuti kolesterol total meningkat (69,79%). Faktor risiko tertinggi pada stroke ischemic adalah gula darah meningkat (47,89%) dan pada stroke hemorrhagic adalah hipertensi (100,00%). Faktor risiko tertinggi pada seluruh pasien adalah hipertensi (82,30%). Kesimpulan: Berdasarkan hasil penelitian ini disimpulkan bahwa stroke tipe ischemic lebih banyak dari tipe hemorrhagic dengan faktor risiko utama hipertensi, sedangkan stroke ischemic terutama dipengaruhi oleh peningkatan gula darah.Kata kunci: stroke ischemic, stroke hemorrhagic, faktor risiko strokeAbstractStroke is a disease caused by disorder of brain blood circulation with many risk factors that contribute in this disease, consist of non modifiable risk factor including age and sex and modifiable risk factors example hypertension, high glucose level, dyslipidemia, and jobs. This study aimed to determine the distribution of the type of stroke and the risk factors that affect to stroke patients who were treat in South Solok hospital.Methods: This research is descriptive research using secondary data, including the patient’s medical record. The data including age, gender, blood pressure, glucose level, lipid profile when the first patient in the hospital, and jobs. The samples were all stroke patients who had been treat in the Department of Internal Medicine of South Solok hospital in the period from January 1st 2010 until June 31th 2012 that meet the inclusion criteria.The results: The results showed the highest proportion of strokes were ischemic stroke (61.46%), women (54.17%) aged> 50 years (81.25%) who work as housewives (43.75%). The highest of modifiable risk factors are hypertension (82.30%) followed by increases in total cholesterol (69.79%). The highest risk factors for ischemic stroke is high glucose level (47.89%) and for hemorrhagic stroke is hypertension (100.00%). The highest risk in both ischemic stroke and hemorrhagic is hypertension (82.30%).Conclusion: Based on the end result, we can concluded that the insidence of ischemic stroke disease is greater than hemorrhagic stroke, and as the main risk factor is hypertension, mean while ischemic stroke is most affected by high glucose level.Keywords: stroke ischemic, stroke hemorrhagic, faktor risiko stroke

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EVALUATION OF RISK FACTORS AND TREATMENT PATTERNS OF CVA

International Journal of Advanced Research ◽

10.21474/ijar01/12426 ◽

2021 ◽

Vol 9 (02) ◽

pp. 136-143

Author(s):

Gyana Deepa.T ◽

◽

Vaishnavi V. ◽

Sahithi V. Pharm D. ◽

CH. Sridevi ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Prospective Observational Study ◽

Hemorrhagic Stroke ◽

Treatment Options ◽

General Medicine ◽

Symptomatic Treatment ◽

Lifestyle Modifications ◽

Medicine Department ◽

Back Ground

Back ground: Cerebro Vascular Accident is a rapidly developing signs of focal disturbances which lasts for more than 24hours and is divided into 3 types- Ischemic stroke, Hemorrhagic stroke, Transient ischemic stroke. Objective: To assess drug treatment pattern of anti-platelets, the involvement of clinical pharmacist to improve the patient outcome, the risk factors of stroke and monitor the risk of anti-platelets. Methods and methodology: A hospital based prospective observational study is conducted in neurology and general medicine department for 6 months meeting the inclusion criteria by obtaining information from the case sheets, laboratory reports and on an interview with the patient. Discussion: Among 80 patients, most of the cases reported were from the age group of 51-60yrs and males were more prone to stroke. Ischemic stroke is seen majorly and strokes are mostly diagnosed with MRI,CT scan, ECG and were treated with Aspirin and Atorvastatin (symptomatic treatment). Conclusion: Stroke (Cerebro Vascular Accident) is the second leading cause of death. Major risk factors of stroke include hypertension and diabetes mellitus. Prevention of these diseases can prevent stroke. People with these diseases are risk factors to stroke.With lifestyle modifications and medication adherence can reduce the risk of stroke. According to the study, majority of patients were males, people who smoke and consume alcohol are also prone to stroke. In this study, we dealt with the risk factors of stroke and its treatment options and lifestyle modifications which can prevent the risk of stroke.

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Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.165427 ◽

2016 ◽

Vol 7 (01) ◽

pp. 72-76 ◽

Cited By ~ 1

Author(s):

Lukman Femi Owolabi ◽

Aliyu Ibrahim ◽

Ibrahim Musa

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Clinical Characteristics ◽

Hemorrhagic Stroke ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Posterior Circulation ◽

Predictors Of Outcome ◽

Posterior Circulation Stroke

ABSTRACT Background: Posterior circulation stroke (PCS), though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6%) of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7) and 13 females (mean age 46.3 ± 13.7). Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7). However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9%) patients. Hypertension was the most common risk factor (86%). Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7%) patients had an ischemic stroke. Twenty-one (36.8%) of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

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Abstract TP186: Incidence and Risk Factors for Stroke and All-Cause Mortality in Korean Adults Congenital Heart Diseases

Stroke ◽

10.1161/str.51.suppl_1.tp186 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jin-Man Jung ◽

Hong Ju Shin ◽

Jae-Young Kim ◽

Woo-Keun Seo

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Heart Diseases ◽

Multivariable Analysis ◽

Control Group ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

All Cause Mortality

Objective: To compare incidence of ischemic stroke, hemorrhagic stroke and all-cause mortality in Korean adults congenital heart disease (ACHD) to that of control and scrutinize risk factors for these outcomes. Methods: Subjects aged over 20 were collected from the Korea National Health Insurance Service from 2006 through 2017. ACHD group as case was extracted from the diagnosis records related to CHD according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD 10). Those without CHD (control group) was selected as 4 controls for each patient through random sampling. We compared incidence rate of ischemic stroke, hemorrhagic stroke and all-cause mortality. Cox proportional hazard models were used to investigate relevant risk factors for each of outcomes. Results: Case and control group were 49,445 and 249,649, respectively. Age-adjusted rates of ischemic stroke, hemorrhagic stroke and all-cause mortality in case was by about 4 times more higher than those of control. Cumulative survival plot demonstrated that ACHD was associated with ischemic stroke (HR 1.31 95% CI 1.25-1.36), hemorrhagic stroke (HR 1.49 95% CI 1.36-1.63), and all-cause mortality (HR 1.41 95% CI 1.35-1.46). Case group was associated with younger age, female, hypertension, diabetes mellitus, coronary artery disease, heart failure, atrial fibrillation (all p <.001). In Cox proportional hazard model for ischemic stroke, diabetes (HR 2.13 95% CI 1.93-2.35) and coararctation of aorta (HR 1.54 95% CI 1.13 - 2.09) carried highest risk. In multivariable analysis for hemorrhagic stroke, hypertension (HR 2.28 95% CI 1.74-2.98) was highest risk factor. Multivariable analysis for all-cause mortality showed that congestive heart failure (HR 1.78 95% CI 1.65-1.92) and Eisenmenger syndrome (HR 2.91 95% CI 2.53-3.35) was highest risk factor. Conclusions: Korean ACHD patients have significantly higher incidence of co-morbidities including hypertension, diabetes mellitus, several heart diseases. They have a higher tendency of ischemic, hemorrhagic stroke and mortality. These findings suggest that medical surveillance and risk factor management is sustainedly needed for ACHD patients to reduce stroke and mortality in the future.

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Changing Epidemiology of Stroke in Nepalese Population

Nepal Journal of Neuroscience ◽

10.3126/njn.v15i1.20021 ◽

2018 ◽

Vol 15 (1) ◽

pp. 10-18

Author(s):

Amit Thapa ◽

Bidur KC ◽

Bikram Shakya ◽

Dipesh Kumar Yadav ◽

Karjome Lama ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Teaching Hospital ◽

Hemorrhagic Stroke ◽

Surgical Intervention ◽

Vegetative State ◽

College Teaching ◽

Diabetic Patients ◽

Medical College ◽

First Time

Corrigendum:The article published in Nepal Journal of Neurosciences 2018;15:10-18 by Amit Thapa et al was mistakenlypublished with wrong affi liation of some of the co-authors. The correct affi liation of the co-authors should read asBikram Shakya, MBBS, MS, MChLecturerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, NepalDipesh Kumar Yadav, MBBSMedical OfficerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, NepalKarjome Lama, MBBSMedical OfficerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, Nepal Abstract: We are witnessing changing patterns in stroke in our practice. Documenting changes in epidemiological profile are important for public health policy. We hereby present analysis of patients with stroke to stress upon the dynamics and update the improvement in their care. We retrospectively studied all patients with first time stroke presenting in Kathmandu Medical College Teaching Hospital during June 2012 till November 2015. Diagnosis was made on clinico-radiological basis with prospective follow up for at least 1 year from the event. Risk factors as well outcome in terms of Glasgow outcome score were studied. Statistical analysis was performed on SPSS. A total of 1017 patients of 16260 patients admitted to the hospital during the study period had first time stroke, a hospital based annual incidence of stroke of 64 per thousand admissions was hence calculated. Mean age was 55 years with 60.5% males. 503 patients (49.5%) had infarction with 20 patients having hemorrhagic conversion while 3 had TIA. 50.2% had hemorrhagic stroke. 56.7% females had ischemic stroke whereas 54.9% of males had hemorrhagic stroke (p=0.002). Common risk factors like HTN (54.7%), Smoking (41.5%), Alcohol (39.2%), dyslipidemia (34.1%) and DM (4.8%) were seen with stroke however, active smoker were more at risk of hemorrhagic stroke (p=0.000) while diabetic patients for ischemic stroke (p=0.000). Due to availability of neurosurgical services, 14.6% patient could undergo procedures like decompressive craniectomy, hematoma evacuation, CSF diversion procedures and carotid endarterectomy for stroke. 66.9% patients required surgical intervention within 48 hours of admission. We had 30 days mortality of 0.5% mortality in this series (majority in hemorrhagic stroke), however over 3 years duration of study mortality rose to 8.3% (majority in ischemic stroke). Almost 88.5% patients achieved mRS< Nepal Journal of Neuroscience, Volume 15, Number 1, 2018 11 2 over a period of 3 years. Persistent vegetative state was seen in 7.6% cases after 1 year. We observe a very high incidence of hemorrhagic stroke in general with higher than reported proportion of females being involved with ischemic stroke in our series. Most of the vegetative state conditions occurred in ischemic stroke patients however early mortality was common in hemorrhagic stroke. This change in pattern of stroke as well as need of surgical intervention mandates early involvement of neurosurgical services. Poor long term prognosis in ischemic stroke may be reversed by timely thrombolytic services and prevented by mitigating risk factors. Nepal Journal of Neuroscience 15:10-18, 2018

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Risk Factors for Incident Stroke and Its Subtypes in China: A Prospective Study

Journal of the American Heart Association ◽

10.1161/jaha.120.016352 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Wenwei Qi ◽

Jing Ma ◽

Tianjia Guan ◽

Dongsheng Zhao ◽

Ameen Abu‐Hanna ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Prospective Study ◽

Socioeconomic Factors ◽

Physical Inactivity ◽

Intervention Program ◽

Hemorrhagic Stroke ◽

Cox Regression ◽

Cox Regression Analysis ◽

Negatively Associated

Background Managing risk factors is crucial to prevent stroke. However, few cohort studies have evaluated socioeconomic factors together with conventional factors affecting incident stroke and its subtypes in China. Methods and Results A 2014 to 2016 prospective study from the China National Stroke Screening and Intervention Program comprised 437 318 adults aged ≥40 years without stroke at baseline. There were 2429 cases of first‐ever stroke during a median follow‐up period of 2.1 years, including 2206 ischemic strokes and 237 hemorrhagic strokes. The multivariable Cox regression analysis indicated that age 50 to 59 years (versus 40–49 years), primary school or no formal education (versus middle school), having >1 child (versus 1 child), living in Northeast, Central, East, or North China (versus Southwest China), physical inactivity, hypertension, diabetes mellitus, and obesity were positively associated with the risk of total and ischemic stroke, whereas age 60 to 69 years and living with spouse or children (versus living alone) were negatively associated with the risk of total and ischemic stroke. Men, vegetable‐based diet, underweight, physical inactivity, hypertension, living in a high‐income region, having Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical System were positively associated with the risk of hemorrhagic stroke, whereas age 60 to 69 years was negatively associated with the risk of hemorrhagic stroke. Conclusions We identified socioeconomic factors that complement traditional risk factors for incident stroke and its subtypes, allowing targeting these factors to reduce stroke burden.

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