EPIDEMIOLOGY AND PREVENTION OF STROKE INTRDUCTION Stroke cerebrovascular
EPIDEMIOLOGY AND PREVENTION OF STROKE
INTRDUCTION • Stroke (cerebrovascular disease ) : Sudden loss of brain function due to vascular lesions • Leading cause of death • Major source of morbidity & disability & of high economic impact $ • Can occur in children but different risk factors 1
DESCRIPTIVE EPIDEMIOLOGY • Incidence: In usa after age of 75 = 10 -20/1000 • High risk groups: – Age: - Stongly related to age -After age of 55 incidence doubles in each successive decade - Mortality with age – Sex: > in males – Race: - Mortality more in blacks in usa 3
DESCRIPTIVE EPIDEMIOLOGY • Time trends: – There is a striking in stroke mortality attributed mainly to: » HTN control » Secodary prevention of stroke among TIA patients » smoking in some countries » Impoved treatment measures 4
RISK FACTORS Generally similar to CAD • Major risk factors: – 1 - hypertension (The major risk factor) – 2 - Smoking – 3 - Hyperlipedemia – 4 - DM – 5 - Heart disease – 6 - Polycythemia – 7 - Thrombocythemia 5
RISK FACTORS • Other risk factors: – – – – – 1 - Positive family history 2 - Cotraceptive pills 3 - Previous history of stroke or TIA 4 - Presence of carotid bruit 5 - Obesity 6 - Physical inactivity 7 - High alcohol intake 8 - drug abuse 9 - trauma 10 - Presence of CAD or peripheral vascular disease 6
PREVENTION • 1 - Primary prevention • By detecting(including screening) and cotrolling the risk factors especially: » HTN » Smoking » Hypercholesterolaemia » DM » Heart disease » TIA » Polycythemia 7
PREVENTION – Asprin use suggested but not yet proven – The important role of community health action • 2 - Screening and early detection » No definite test for early detection of stroke » Screening for carotid bruit (by auscultation or non invasive testing) among persons with established stroke risk factors may be wise 8
PREVENTION • 3 - Treatment – A: For acute stroke » Rehabilitation » Anticoagulants ( for some cases ) – B: For preventing further stroke » Antiplatelet therapy(asprin or other drugs) » Carotid endarterectomy(in some cases) 9
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