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
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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)