Clinical study of acute stroke with special reference to Greek stroke scoring system
Keywords:Clinical features, Clinical presentation, CT scan, Greek score, Hemorrhagic stroke, Ischemic stroke, Risk factors
Background: Stroke is becoming an important cause of premature death and disability in low-income and middle-income countries like India, largely driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors. Rapid access to CT is virtually impossible for all patients with a cerebrovascular event especially in resource poor countries like ours. Aims and objectives of the study were to study the clinical characteristics of patients suffering from acute stroke and to study the efficacy of Greek stroke scoring system in differentiating acute intracerebral infarction and hemorrhagic stroke
Methods: Present study was carried out in 50 consecutive patients of stroke admitted to department of Medicine, Guru Nanak Dev Hospital (attached to Government Medical College), Amritsar, Punjab, India. It was a prospective, observational, hospital based study.
Results: Maximum number of stroke patients i.e. 36% were in the age group of 61-70 years. Mean±sd age for ischemic and hemorrhagic stroke was 67.9±11 and 57±9 years respectively. 36 patients (72%) had ischemic stroke and hemorrhagic stroke was seen in 14 patients (28%). Among the modifiable risk factors of stroke-hypertension was the most common (68% cases) followed by dyslipidemia (64%), DM (30%), chronic alcohol intake (28%). In the present study, Greek score had a high sensitivity (97%) and positive predictive value (97%) in diagnosing ischemic stroke. It also had excellent specificity (97%) and negative predictive value (97%) in diagnosing hemorrhagic stroke
Conclusions: Targeting the risk factors for preventing stroke in the first place will help in reducing burden of this often-disabling disease. The CT scan remains as a gold standard in differential diagnosis of stroke and Greek scoring system may be used as a guide in management only when resources are limited and CT scan facilities are not available.
Strong K, Mathers C, Bonita R. Preventing stroke: saves lives around the world. Lancet Neurology. 2007;6:182-7.
Dalal P, Bhattacharjee M, Vairale J, Bhat P. UN millennium development goals: can we halt the stroke epidemic in India? Ann Indian Acad Neurol. 2007;10(3):130.
Mathers CD, Lopez AD, Murray CJL. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors.
Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke. 2013;15(3):128-34.
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2013;44(7):2064-89.
Hawkins GC, Bonita R, Broad JC, Anderson NE. Inadequacy of Clinical Scoring systems to Differentiate Stroke Subtypes in Population-Based Studies. Stroke. 1995;26:1338-42.
Efstathiou SP, Tsioulos DI, Zacharos ID, Tsiakou AG, Mitromaras AG, Mastorantonakis SE, et al. A new classification tool for clinical differentiation between haemorrhagic and ischaemic stroke. Journal of Internal Medicine. 2002;252:121-9.
Marwat MA, Usman M, Hussain M. Stroke and its relationship to risk factors. Gomal J Med Scie. 2009;7(1).
Naik M, Rauniyar RK, Sharma UK, Dwivedi S, Karki DB, Samuel JR. Clinico-radiological profile of stroke in eastern Nepal: A computed tomographic study. Kathmandu Univ Med J. 2006;4(2):161-6.
Rodríguez T, Malvezzi M, Chatenoud L, Bosetti C, Levi F, Negri E, et al. Trends in mortality from coronary and cerebrovascular diseases in the Americas: 1970-2000. Heart 2006;92:453-60.
Abu Naser S, Nur N, Shahriar M, Alam B, Miah T. Clinical presentation and epidemiology of stroke – A study of 100 cases. J Med. 2009;10:86-9.
Eapen RP, Parikh JH, Patel NT. A study of clinical profile and risk factors of cerebrovascular stroke. Gujarat Med J. 2009;64:48-54.
Baidya OP, Chaudhuri S, Devi KG. Clinico-epidemiological study of acute ischemic stroke in a tertiary hospital of northeastern state of India. Inter J Biomed Adv Res. 2013;4:661-5.
Sotaniemi KA, Pyktinen J, Myllyia VV. Correlation Of Clinical And Computed Tomographic Findings In Stroke Patients. Stroke. 1990;21:1562-6.
Vila EM, Irimia P. The cost of stroke: Cerebrovascular Diseases. 2004;17:124-9.
Vaidya C, Majmudar D. A retrospective study of clinical profile of stroke patients from GMERS medical college and hospital, Gandhinagar, Gujarat. International Journal of Clinical Trials. 2014:62-6.
Benerjee TK, Mukharjee CS, Sarkhel A. Stroke in urban population of Calcutta–An epidemiological study. Neuroepidemiology. 2001;2(3):201-07.
Mahajan SK, Kashyap R, Sood BR, Jaret P, Mokta J, Kaushik NK, et al. Stroke at moderate altitude. JAPI. 2004;52:699-704.
Bharosay A, Bharosay VV, Bandyopadhyay D, Sodani A, Varma M, Baruah H. Effect of lipid profile upon prognosis in Ischemic and Haemorrhagic Cerebrovascular stroke. Ind J Clin Biochem. 2013;29(3):372-6.
Sengupta P, Benjamin NS, Benjamin A. Some observations on diabetes mellitus in Ludhiana, Punjab. Indian J Public Health. 2010;54:46-7.
Srinivasan K. Ischemic cerebrovascular disease in the young. Two common causes in India. Stroke. 1984;15:733-5.
Zhou BF, Zhang HY, Wu YF, Li Y, Yang J, Zhao LC, et al. Ecological analysis of the association between incidence and risk factors of coronary heart disease and stroke in Chinese populations. CVD Prevent. 1998;1:207-16.
Goldman MR, Rogers EL, Rogers MC. Subarachnoid hemorrhage associated with unusual electrocardiographic changes. JAMA. 1975;234:957.
Misbach J, Wendra A. Clinical pattem of hospitalized strokes Clinical pattern of hospitalized strokes in 28 hospitals in Indonesia. Med J Indones. 2000;9:29-34.
Donnan GA, Mcneil JJ, Adena MA. Smoking as a risk factor for cerebral ischaemia. Lancet. 1989;8664:643-7.
Kora SA, Doddamani GB, Devi P, Goorannavar SM, Biradar S. Clinical profile of posterior circulation stroke in a tertiary care centre in southern India. J Clinical Diag Res. 2011;5(2):217-21.
Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The Stroke database: design, methods and baseline characteristics. Stroke. 1988;19:547-554.
Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, et al. The Harvard cooperative stroke registry: A prospective registry. Neurology. 1978;28(8):754.
Goswami RP, Karmakar PS, Ghosh A. Bedside utility of clinical scoring systems in classifying stroke. Ind J Med Scie. 2013;67:137-45.