OBJECTIVES

At the end of the class the student should be able to

 To understand the who definiton of stroke
 Classify the risk factors
 Explain the prevalence of stroke in the western world .
 Explain the prevalence of stroke in pakistan
 To communicate the prevention of cvd .

WHO definition of stroke

Clinical syndrome characterised by
 developing clinical symptoms
 loss of cerebral functions and symptoms lasting for more than 2
hours
 OR
 leading to death with no apparent cause other than vascular
origin.

STROKE
 Is an acute and severe manifestation of CVD
 vascular in origin
 physically and mentally crippling

CAUSES OF STROKE
Disturbance in cerebral function is caused by 3 abnormalities

 STENOSIS
 OCCLUSION
 RUPTURE OF ARTERIES

PRESENTATION
Manifestations are by neurological symptoms and signs related to
SITE OF AREA INVOLVED
EXTENT
UNDERLYING CAUSE

TYPES OF STROKE
Most common form of stroke is due to
 Cerebral thrombosis
 Intra cerebral Haemorrhage
 Subarachanoid haemorrhage / cerebral embolism

PREVALENCE OF STROKE
 The Framingham heart study (which predominantly includes
whites )showed that during the past 50 yrs the ANNUAL
INCIDENCE OF STROKE HAS DECLINED BUT LONG TERM RISK
DECLINES AT A SLOWER RATE.
 A similar incidence was not observed in blacks.
Prevalence depends upon
 incidence
 mortality
 mean length of survival after stroke .
  Hypertension is the leading risk factor for stroke and greater
clinical and community action is needed.
 In higher age groups the prevalence of stroke was higher in men
than in women .
 In lower age groups American Indians have the highest where as
Asians have the lowest rate of prevalence.
 Incidence of Silent Cerebral Infarction increases with age.

STROKE IN THE WEST

 Every year 700 000 people experience a new or recurrent stroke.
 500 000 are first attacks
 200 000 are recurrent attacks
 On an average every 45 secs someone in US has a stroke .
 Every year 46 000 more women than men have a stroke

PREVALENCE OF STROKE IN THE WEST

 Incidence rates of stoke in American Indian men are 1.25 times
greater than women (b/w ages 45 and 74) .
 Difference in incidence rates b/w sexes is higher at younger age
but non existent at older ages.
 Incidence of silent cerebral infarction increases with age.
 Presence of TIA increases with age in both men and women.

INCIDENCE
Ischaemic stroke 88%
Intra cerebral stroke 9%
Subarachanoid stroke 3%

RISK FACTORS

 ELEVATED BLOOD LIPIDS (cholesterol and triglycerides )

 HEART DISEASE / CARDIAC ABNORMALITIES
  PSYCHOSOCIAL STRESS (depression)
 ORAL CONTRACEPTIVES
 AGE AND SEX
 FAMILY HISTORY

ROLE OF NUTRITION AND LIFE STYLE MODIFICATION IN STROKE

 The importance of NUTRITION in the prevention of many health
problems is well recognised.
 Consume healthy foods
 Ample anti oxidants
 Adequate supplements like vitamins and minerals .
 Exercise and relaxation

STROKE IN PAKISTAN
 Burden of stroke risk factors in Pakistan is enormous .
 Every 3rd person over 45 yrs has H/T as a result of poor
compliance on patients part OR
 Poor updated knowledge on physician’s part.
 Despite lack of epidemiological data the burden of stroke is high
in pakistan compared to other SA countries .
 The mean age of patients with stroke is less compared to the
patients in the developed world .
 Approx 20% of patients are < than 45 yrs .
 H/T is by far the most common risk factor in a young stroke
patients.
HIGH QUALITY STROKE SERVICES ARE NOT WIDELY AVAILABLE ,
 there is an urgent need. of improvement in the infra
structures to conduct
 well designed epidemiological studies and
 create awareness in general public in order to meet
the future challenges
  No large scale epidemiological studies are available to
determine the true incidence of stroke in Pakistan
 Only one published prevalence study from Pakistan
conducted on Pushtoon community residing in karachi
.
 This study reports a prevalence of 48% that was alike
both in men and women the highest reported
prevalence in the world. results have to be interpreted
with caution as non validated questionnaire was used
and no imaging study was performed to confirm
diagnosis.
 The community hospital based studies reveal a
relatively high proportion of young stroke.
 The mean age of stroke varies from52 to 66 yrs.
 The younger age of onset is in with keeping with the
data from the Indian sub continent that CHD manifests
manifests 10 yrs earlier in this region compared to the
rest of the world.

CONCLUSION

 The mean age of patients with stroke in Pakistan is less

compared to patients In the developed world .
 Ischemic strokes are more common than haemorrhagic strokes
 intracerebral haemorrhages are higher compared to the western
population .
 There is urgent need to improve the infra structure and conduct
well defined epidemiological studies.
 To create awareness in general public regarding stroke and to
meet future challenges.
 REFERENCES
Public Health and Community Medicine by Mohd Illyas addition 8th .
. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world:
Global Burden of Disease Study.
Lancet 1997; 349: 1269-76. Lancet 2005; 365: 2160-61
World Health Organization (WHO). The Atlas of Heart Disease and
Stroke.http://www.who.int/cardiovascular_diseases/resources/atlas/en
/

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