Etiology of stroke in young pakistani adults; results of a single center study

Pakistan Journal of Neurological Sciences (PJNS), Dec 2015

The aim of this study was to determine the demographic profile and incidence of young stroke at a tertiary care setup in Islamabad, Pakistan. Materials and Methods: This single centre, cross sectional study was conducted by recruiting 119 patients of either gender, ≥ 12and ≤ 45 years of age with stroke and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Results: Total number of young strokes was 119 out of a total of 322 strokes i-e-, 36.9 %; 1/3rd strokes were in ≤ 45 years of age. Ischemic arterial strokes were 47% (56 out of 119) while venous ischemic strokes were 11.7 % (14 out of 119) and almost all in females (13 out of 14; 92.8 %).Infective causes of central nervous system were identified in24.3 % (29 out of 119). 49 patients (41.1 %) had hemorrhagic strokes. Major individual risk factors for stroke included hypertension identified in 35 (29.4 %)followed by diabetes mellitus in 8 (6.7 %) patients. Amongst infectious causes, CNS tuberculosis was the major infection associated with young stroke i-e-, 89.6 % (26 out of 29). Conclusion: Nearly 1/3rd of strokes in our population are in young.While risk factors in general for stroke stand true for young stroke as well namely hypertension and diabetes, CNS infections are a major cause of young stroke in Pakistan; particularly CNS TB. While majority of strokes in elderly are ischemic, strokes in young comparatively are almost equally divided between ischemia and hemorrhage i-e-, 1.4:1. 1/5th of these ischemic strokes are due to cerebral venous thrombosis. National level guidelines should therefore adopt different strategies for primary and secondary prevention, laboratory work up and imaging, and treatment of stroke in young.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1044&context=pjns

Etiology of stroke in young pakistani adults; results of a single center study

V O L . Etiolog y of stroke in young pakistani adults; results of a single center study Ali Zohair Nomani 0 1 2 4 Shahzad Mughal 0 1 2 4 Pakistan Institute of Medical Sciences,Islamabad,Pakistan 0 Pakistan Institute of Medical Sciences , Islamabad , Pakistan 1 Pakistan Institute of Medical Sciences , Islamabad 2 Pakistan Institute of Medical Sciences , Islamabad , Pakistan 3 Department of Neurology, Pakistan Institute of Medical Sciences , 44000, Islamabad , Pakistan 4 Ali Zohair Nomani , Mansoor Iqbal, Uzma Jamil, Sumaira Nabi, Shahzad Mughal, Mazhar Badshah, Haris Majid Rajput , Rao Sohail Yasin Khan Recommended Citation Article 6 See next page for additional authors Follow this and additional works at: http://ecommons.aku.edu/pjns Part of the Neurology Commons Etiology of stroke in young pakistani adults; results of a single center study Authors Ali Zohair Nomani, Mansoor Iqbal, Uzma Jamil, Sumaira Nabi, Shahzad Mughal, Mazhar Badshah, Haris Majeed, and Rao Sohail yasin khan Thi s original article is available in Pakistan Journal of Neurological Sciences (PJNS): http://ecommons.aku.edu/pjns/vol10/iss4/6 O R I G I N A L A R T I C L E ETIOLOGY OF STROKE IN YOUNG PAKISTANI ADULTS; RESULTS OF A SINGLE CENTER STUDY Correspondence to: Ali Zohair Nomani, Department of Neurology, Pakistan Institute of Medical Sciences, 44000, Islamabad, Pakistan. Email: . Telephone: +92-3365295351 Date of Submission: June 22, 2015 Date of Revision: September 18, 2015 Date of Acceptance: October 1, 2015 Objectives: The aim of this study was to determine the demographic profile and incidence of young stroke at a tertiary care setup in Islamabad, Pakistan. Materials and Methods: This single centre, cross sectional study was conducted by recruiting 119 patients of either gender, ≥ 12and ≤ 45 years of age with stroke and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Results: Total number of young strokes was 119 out of a total of 322 strokes i-e-, 36.9 %; 1/3rd strokes were in ≤ 45 years of age. Ischemic arterial strokes were 47% (56 out of 119) while venous ischemic strokes were 11.7 % (14 out of 119) and almost all in females (13 out of 14; 92.8 %).Infective causes of central nervous system were identified in24.3 % (29 out of 119). 49 patients (41.1 %) had hemorrhagic strokes. Major individual risk factors for stroke included hypertension identified in 35 (29.4 %)followed by diabetes mellitus in 8 (6.7 %) patients. Amongst infectious causes, CNS tuberculosis was the major infection associated with young stroke i-e-, 89.6 % (26 out of 29). Conclusion: Nearly 1/3rd of strokes in our population are in young.While risk factors in general for stroke stand true for young stroke as well namely hypertension and diabetes, CNS infections are a major cause of young stroke in Pakistan; particularly CNS TB. While majority of strokes in elderly are ischemic, strokes in young comparatively are almost equally divided between ischemia and hemorrhage i-e-, 1.4:1. 1/5th of these ischemic strokes are due to cerebral venous thrombosis. National level guidelines should therefore adopt different strategies for primary and secondary prevention, laboratory work up and imaging, and treatment of stroke in young. INTRODUCTION There is significant socioeconomic impact in terms of morbidity and mortality especially when stroke affects young patients. Exact age range for defining young stroke, remains debatable; it is generally believed that the risk factors and underlying etiologies tend to become similar to the older patients at around 45 years of age. Therefore, many research studies define “stroke in young” as occurring in patients at age 45 years or less.1 Compared to the older adults, the incidence, risk factors, and etiology are distinctly different in younger ischemic stroke. Accordingly, cardioembolism (20%–35%), dissection of extracranial arteries (6%–25%), drugs (10%), and hypercoagable states (5%–10%) are relatively more commonly detected in younger stroke patients. Additional factors such as migraine, pregnancy and oral contraceptive use are also observed more commonly in young people.2 For all stroke (ischemic and hemorrhagic), overall incidence rates under the age of 45 years range from 7 to 15 in 100,000 people/year.3 Under the age of 45, there may be a greater incidence of stroke among developing countries, such as Libya with a reported rate of 47 in 100,000 people/year for all strokes.4 The aim of this study was to determine the demographic profile and incidence of young stroke at a tertiary care setup in Islamabad, Pakistan and to discuss trends along with relative frequencies of its various etiologies. This would help formulate strategic management protocols for stroke in young at tertiary care level and expand our knowledge of this entity in developing countries like Pakistan. Moreover, there is scarce local data from Pakistan regarding young stroke and this study would help define its basic demographics f (...truncated)


This is a preview of a remote PDF: https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1044&context=pjns

Ali Zohair Nomani, Mansoor Iqbal, Uzma Jamil, Sumaira Nabi, Shahzad Mughal, Mazhar Badshah, Haris Majeed, Rao Sohail yasin khan. Etiology of stroke in young pakistani adults; results of a single center study, Pakistan Journal of Neurological Sciences (PJNS), 2015, Volume 10, Issue 4,