ABSTRACT
AIM: Limited data regarding stroke subtypes exist from South Asian countries. The aim of the study was to determine the pattern of ischemic stroke subtypes and their associated risk factors, in a 10-year long hospital-based registry in the South Indian city of Hyderabad. MATERIALS AND METHODS: The Hyderabad stroke registry systematically collected clinical, radiological, and laboratory data of fully investigated consecutive stroke patients and studied pattern of ischemic stroke subtypes and their risk factor association. RESULTS: The cohort comprised of 2642 patients: 2072 (78.4%) were ischemic and 570 (21.6%) were hemorrhagic strokes. In the ischemic stroke cohort, the mean age was 54.1 years and 1622 (78.3%) were men. The most common ischemic stroke subtype was large artery atherosclerosis (LAA) comprising 37.6% (n = 779), followed by small vessel occlusion comprising 19.9% (n = 413) and cardioembolism 11% (n = 228). Stroke of other determined etiologies constituted 4.2% (n = 86) and stroke of undetermined etiology was observed in 27.3%. Among patients with LAA, 610 (78.3%) patients had intracranial and 169 (21.7%) had extracranial disease as the underlying mechanism. Risk factor profile demonstrated that hyperlipidemia was significantly associated with LAA and ischemic heart disease with cardioembolic strokes. CONCLUSIONS: The study reveals a distinct pattern of ischemic stroke subtypes in the Indian context that has overlapping features of registries from West and East Asian countries. Both large artery and small vessel diseases are substantially represented with a predominance of intracranial atherosclerosis. The study results have significant implications for developing preventive and management strategies for stroke care and research in India.
ABSTRACT
BACKGROUND AND PURPOSE: Transcranial Doppler (TCD) is often used as a screening tool for detecting intracranial stenosis. Since TCD results may vary among laboratories and sonographers, it requires validation against an imaging modality. We evaluated diagnostic accuracy of TCD performed in our laboratory against time-of-flight (TOF) magnetic resonance angiography (MRA) in detecting intracranial stenosis in patients with acute cerebral ischemia. METHODS: Consecutive patients with acute (<24 hours) cerebral ischemia and intracranial arterial stenosis on MRA underwent both TCD and MRA within 5 hours of each other. TCD was performed by credentialed neurosonologists according to standardized protocol. An independent neuroradiologist interpreting MRA was blinded to TCD findings. We evaluated TCD peak systolic velocities (PSV) in proximal intracranial arteries as predictive of moderate (>50%) and severe (>70%) stenosis on TOF-MRA. RESULTS: One hundred and fifty patients (74% males; mean age 53 years) underwent neurovascular evaluation with TCD and MRA. Twenty-two (14.6%) patients were excluded due to absent temporal acoustic windows. Middle cerebral artery TCD PSV values of >140 cm/s and >180 cm/s were found to predict a >50% and >70% focal stenosis, respectively. Optimal cut-off PSV values for other major proximal intracranial arteries were also established. CONCLUSIONS: TCD performed in our laboratory shows satisfactory agreement with TOF-MRA in diagnosis and grading of proximal intracranial stenosis in patients with acute cerebral ischemia.
Subject(s)
Brain Ischemia/diagnostic imaging , Intracranial Arteriosclerosis/diagnostic imaging , Magnetic Resonance Angiography/methods , Ultrasonography, Doppler, Transcranial/methods , Adult , Aged , Aged, 80 and over , Analysis of Variance , Brain Ischemia/pathology , Female , Humans , Image Interpretation, Computer-Assisted , Intracranial Arteriosclerosis/pathology , Male , Middle Aged , Middle Cerebral Artery/pathology , Predictive Value of Tests , Prospective Studies , ROC Curve , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
BACKGROUND: As infections occur more frequently in developing countries, we carried out this prospective case-control study, to establish the association, if any, between C. pneumoniae antibodies and ischemic stroke particularly in relation to its subtypes. DESIGN: Antibodies (IgG and IgA) to C. pneumoniae in serum were measured by microimmunofluorescence test in 200 consecutive ischemic stroke patients and 200 age and sex matched controls. RESULTS: Seventy two out of 200 ischemic stroke patients (36%) had positive C. pneumoniae antibodies (IgG or IgA), compared to 35 out of 200 controls (17.5%) (p<0.0001). IgG antibody was positive in 64/200 (32%) ischemic stroke patients, compared to 34/200(17%) controls (p<0.0001) and IgA was positive in 20/200(10%) ischemic stroke patients compared to 1/200(0.5%) controls (p<0.0001). Logistic regression analysis showed statistically significant association between C. pneumoniae antibody positivity and ischemic stroke, thereby establishing it as an independent risk factor. Prevalence of C. pneumoniae antibodies was significantly higher in all stroke subtypes (except the stroke of undetermined etiology) compared to controls. CONCLUSION: Significant and independent association was found between C. pneumoniae antibodies and ischemic stroke in this sample of south Indian population. The association was found in all ischemic stroke subtypes, except stroke of undetermined etiology.
