Abstract
Background: Cerebrovascular accident (CVA) is the major leading cause of death and disability in both developed and developing countries. It is a neurological emergency and stroke patient should be taken immediately to a medical facility for diagnosis and treatment. The symptoms of a stroke depend mainly on the area of the brain that has been affected and the amount of tissue damaged.
Aim: The aim of this study was to investigate various clinical presentations in ischemic stroke patients.
Methods: A descriptive hospital-based study of the neurological symptoms and signs of 100 patients with ischemic stroke, including Glasgow Coma Scale (GCS), severe headache, cranial nerve palsy, aphasia, hemiplegia, monoplegia, ataxia, vertigo, eye movement disorder, were analyzed in the study.
Results: We analysed 100 patients having confirmed acute ischemic stroke. UMN types of facial nerve weakness were the most frequent presentation (88%). But it was not found as an isolated presentation and usually associated with limb weakness, aphasia and other cranial nerve weakness. The hemiplegia were the second most frequent presentation (82%), in which left side hemiplegia were dominating (44%) as compared to 38 % in right side .Right side with aphasia were 18% and without aphasia were 20% depending on speech area involved. Pure aphasia without limb weakness was found in only 3 patients ( 3%). Total aphasia irrespective of limb weakness were found in 21 %. Facio-brachial weakness found in 3 % cases while one patient (1%) had pure monoplegic type presentation. Five (5%) patients had acute ataxic manifestation, (5%) had lower cranial nerve involvement and one (1%) has internuclear ophthalmoplegia. Anterior circulation was involved in 62% case and remaining 38% had posterior circulation stroke. Low GCS (< 7) was found in 12 % case mainly in large anterior circulation or extensive brainstem involving stroke patients. Out of which 8% had mortality during hospital stay and remaining 4% were discharge with severe morbidity after prolonged hospital stay.
Conclusion: In the current study facial nerve palsy with limb weakness, acute onset hemiplegia, and aphasia had significantly higher prevalence in ischemic stroke patients.
Keywords: Ischemic Stroke, Nerve Palsy, Aphasia, Hemiplegia.
References
- Murray C, Lopez A. Cambridge, MA: Harvard University Press; 1996. Global health statistics: A compendium of incidence, prevalence and mortality estimates for over 200 conditions.
- Strong K, Mathers C, Bonita R. Preventing stroke: Saving lives around the world. Lancet Neurol. 2007;6:182–7.
- Strong K, Mathers C. The global burden of stroke. In: Mohr JP, Grotta JC, Wolf PA, Moskowitz MA, Mayberg MR, Von Kummer R, editors. Stroke: Pathophysiology, Diagnosis and Management. 5th ed. Philadelphia, PA: Elsevier; 2011. pp. 279–89.
- Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. Lancet Neurol. 2009;8:355–69.
- Williams GR, Jiang JG, Matchar DB, Samsa GP. Incidence and occurrence of total (first-ever and recurrent) stroke. Stroke. 1999;30(12):2523–8.
- Kolominsky-Rabas PL, Sarti C, Heuschmann PU, Graf C, Siemonsen S, Neundoerfer B, et al. A prospective community-based study of stroke in Germany—the Erlangen Stroke Project (ESPro):incidence and case fatality at 1, 3, and 12 months. Stroke. 1998;29(12):2501–6.
- Smith RW, Scott PA, Grant RJ, Chudnofsky CR, Frederiksen SM. Emergency physician treatment of acute stroke with recombinant tissue plasmin-ogen activator:a retrospective analysis. Acad Emerg Med. 1999;6(6):618–25.
- Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, et al. Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke:Emergency Management of Stroke (EMS) Bridging Trial. Stroke 1999;30(12):2598–605.
- Brott T, Adams HP, Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measur-ements of acute cerebral infarction:a clinical examination scale. Stroke. 1989;20(7):864–70.
- PN Sylaja, JD Pandian, S Kaul, MVP Srivastava… Ischemic stroke profile, risk factors, and outcomes in India: The indo-US collaborative stroke project - Stroke, 2018 – Am Heart Assoc
- WHO MONICA Project Principal Investigators. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease) J Clin Epidemiol. 1988;41:105–14.
- Schneider AT, Kissela B, Woo D, Kleindorfer D, Alwell K, Miller R, et al. Ischemic stroke subtypes: a population-based study of incidence rates among blacks and whites. Stroke. 2004;35:1552–1556.
- Tsai CF, Thomas B, Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology. 2013;81:264–272.
- Sridharan SE, Unnikrishnan JP, Sukumaran S, Sylaja PN, Nayak SD, Sarma PS, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke. 2009;40:1212–1218.
- Kaul S, Sunitha P, Suvarna A, Meena AK, Uma M, Reddy JM. Subtypes of ischemic stroke in a metropolitan city of south India (one year data from a hospital based stroke registry). Neurol India. 2002;50:S8–S14
- White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation. 2005;111:1327– 1331.
- Ojaghihaghighi S, Vahdati SS, Mikaeilpour A, Ramouz A.et al, Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemicstroke. World J Emerg Med. 2017;8(1):34-38.
- Nouh A, Remke J, Ruland S. et al; Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management Front Neurol.2014 ,7;5:30.
Corresponding Author
Vinod Kumar Mehta
Assistant professor, Deapartment of Neurology, Geetanjali Medical University, Udaipur, 313001, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.191
