Hospital based epidemiological study of cerebrovascular stroke

Epidemiological studies are essential in order to assess the extent of cerebrovascular disease, its natural cause, major differences between countries, etiological and prognostic factors, and for planning therapeutic trials [Beech et al., 1996]. The present study aimed at evaluating some epidemiological aspects of recent cerebrovascular stroke, evaluating the benefits obtained from different neuroimaging tools such as magnetic resonance imaging [MRI], computerized tomography [CT] and transcranial Doppler ultrasonography [TCD] and evaluating some risk factors of stroke such as age, sex and other demographic characteristics, smoking, hypertension, diabetes, hyperlipidaemia and some hematological, cardiac, and blood chemistry variables. The present study included 235 patients with cerebrovascular stroke admitted to stroke unit in Ain Shams University Specialized Hospital, 173[73.6 percent] patients with cerebral infarction, 26 [11.1 percent] patients with cerebral hemorrhage, 13 [5.5 percent] patients with hemorrhagic infarction, and 23 [9.8 percent] patients with lacunar infarction. The mean age of the total sample of the patients included in our study was [61.75 +/- 11.59], it ranged from 25 to 90 years. We found that there is difference in sex distribution as males [n=161] represent 68.5 percent of patients while females [n=74] represent 31.5 percent, among our male patients III [68.9 percent] were smokers while 50 [32.1 percent] non-smokers and all of our female patients were non-smokers, at the same time, 181 of the patients [77 percent] were hypertensive while 54 of them [23 percent] were non-hypertensive, also, 116 patients [49.4 percent] were diabetic while 119 [50.6 percent] were non-diabetic, and the mean of non-fasting glucose level in cerebral infarction [l92 +/- I07.9mg/dl] was higher than in patients with cerebral hemorrhage [186 +/- 120.5]. Regarding other laboratory parameters we found that mean of total cholesterol in patients with cerebral infarction [207.3mg/dl] was approaching significantly higher [p=0.056] than in patients with cerebral hemorrhage [185.7mg/dl], also, triglyceride level was significantly higher [p=0.03] in patients with cerebral infarction [I48.6mg/dl] than in patients with cerebral hemorrhage [113mg/dl], at the same time, the mean of total leukocytic count was non-significantly higher [p=0.90] in patients with hemorrhagic cerebral infarction [12. l +/- 4.65x10[3]cell/cmm] than in patients with lacunar infarction [10.0565xl0 [3]cell/cmm] than patients with cerebral hemorrhage 9.9565x10[3]cell/cmm], although, the mean of ESR in the total stroke patients was [36.41 +/- 23.48], it was higher in patients with all subtypes of cerebral infarction. Our study confirmed the significance of heart disease as a risk factor for stroke, particularly for ischemic stroke, and hemodynamically significant carotid artery stenosis [>70 percent] was detected in 15 [6.4 percent] patients, of them 14 patients with cerebral infarction while only one patient with cerebral hemorrhage. In our study TCD was done to 133 patients 10 with cerebral hemorrhage and 123 with cerebral infarction, intracranial stenosis was detected in 76 [61.7 percent] patients from those with cerebral infarction, and 3 [30 percent] patients from those with cerebral hemorrhage, and there is statistically significant difference [p=0.013] between ischemic stroke subtypes as intracerebral stenosis was detected in 67 percent of patients with cerebral infarction while only in 30 percent of patients with lacunar infarction The present study included 235 patients with cerebrovascular stroke. The mean age [ +/- SD] of the total sample of the patients included in our study was [61.75 +/- 11.59], it ranged from 25 to 90 years, it included 161 [68.5 percent] males, and 74 [31.5 percent] females. The most common risk factors detected in our stroke patients were, increasing age, smoking, hypertension, diabetes, hyperlipidemia, cardiac diseases, carotid artery stenosis, as well as intracranial arterial stenosis

Evaluation of carotid endarterectomy in post cerebral stroke patients with significant carotid artery lesions

This study was carried out to evaluate the results of carotid endarterectomy after recovery from prior stroke due to a significant carotid artery lesion. Thirty-seven patients with prior for cerebral stroke were included [26 males: 11 females, mean age = 64.5 years]. All patients had good functional recovery with minimal residual deficits. A corresponding significant carotid stenosis [> 70%] was present in 32 patients [86%] and an unstable ulcerated plaque in 5 patients [14%]. Carotid endarterectomy was done 30 days to 6 months post-stroke. Risk factors included smoking [73%], hypertension [68%], diabetes mellitus [57%], coronary artery disease [35%] and hyperlipidemia [41%]. Mean follow up was 18 months [range 6-37 months]. There was one postoperative death as a result of intraoperative stroke and another from myocardial infarction resulting in a combined perioperative stroke/mortality of 5.4%. No other neurological events were encountered during the rest of the follow up period. Complications related to the procedure included reactionary hemorrhage [2.7%], hoarseness of voice [5.4%], and transient ramus mandibularis palsy [2.7%]. This experience supports the benefit of carotid endarterectomy in post-stroke patients with significant carotid artery lesions. It is a safe and reliable procedure in preventing recurrent stroke in this group of patients