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Category: Volume 07 Issue 07 July 2019
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Title: An observational study of clinico-etiological profile of Posterior circulation stroke patients in a new tertiary care hospital in North Odisha

Authors: Bibhu P. Behera, D. N. Maharana, Partha S. Mohanty

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.56

Abstract

Background: Posterior circulation stroke is less common than stroke involving the anterior circulation. Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Early diagnosis of stroke is essential so that appropriate preventive therapies may be instituted.

Materials & Methods: This observational study was carried out among 80 posterior stroke patients from June 2018 to Jan 2019 of all new patients admitted with stroke in Pandit Raghunath Murmu Medical College & Hospital, Baripada, Mayurbhanj, Odisha, India.

Results: The total number of posterior circulation stroke patient was 80, 10.05% of 796 total stroke patients, posterior circulation ischemic stroke in 12.68% of cases out of 481 ischemic stroke patients in our study. In our study, 76.25% patients had ischemic stroke and 23.75% patients had hemorrhagic stroke. Average age of patient in hemorrhagic stroke was 57.9 years and average age of patient in ischemic stroke was 61.0 years. Hypertension (72.50%) was the most common associated risk factor followed by dyslipidemia (48.75%) followed by tobacco chewing (32.50%). Motor involvement (72.5%) was commonest clinical feature among posterior circulation stroke followed by speech involvement (58.75%) and altered sensorium (48.75%).

Conclusions: There are very few studies on clinical profile and outcome in PCS we would need more studies solely on PCS elucidating particularly the causes and predictors of outcomes to help establish an appropriate management strategy for PCS.

Keywords: Cerebrovascular stroke, Ischemic stroke, Hemorrhagic stroke, Risk factors, Hypertension, Diabetes.

References

  1. Stroke, World Heart Federation. The global burden of stroke. Available from: http://www.worldheart federation.org/cardiovascular-health stroke. [Last updated on 2015 Jan 02, Last assessed on 2015 Jul 01].
  2. Anthony S Fauci, Dennis L., Kasper L, Dan L. Longo, Stephen L. Hauser, J. Larry Jameson, Joseph Loscalzo.eds Harrison’s Principles of Internal Medicine. 20th ed. United States of America, NY: McGrawHill; 2018:3068-3079.
  3. Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke 2013;15(3):128-34.
  4. Kubik CS, Adams RD. Occlusion of the basilar artery. A clinical and pathological artery. Brain. 1946; 69-73-121.
  5. Piechowski-Jewisk B, Bongusslavsky J. Vascular disorders of the posterior circulation-anatomicoclinical overview. www.acnr.co.uk/pdfs/vol.4.issue 2.
  6. Devuyst G, Bongusslavsky J, Meuli R, Mancayo J, deFreitas G, Van MELLE G. Stroke or TIAs with Basilar artery stenosis or occlusion clinical patterns and outcome. Arch Neurology 2002;59:567-73.
  7. Easton DJ, Fauci AS, Isselbacher KJ. Cerebrovascular disease. In: Anonymous Harrison's Principle of Internal Medicine. Fauci AS, Longo D, Kasper DL, Wilson JD, Martin JB, editors. , eds. New York, NY: McGraw Hill. 1998:2325-48.
  8. Glass TA, Hennessey PM, Pazdera L, Chang HM, Wityk RJ, Dewitt LD, et al. Outcome at 30 days in the New England Medical Center Posterior Circulation Registry. Arch Neurol. 2002;59(3):35976.
  9. Caplan LR. Vertebrobasilar teritary ischemia: an overview. In: Posterior Circulation Disease: Clinical Findings, Diagnosis, and Management. Cambridge, England: Blackwell Science Ltd. 1996:179-97.
  10. Ratnavalli E, Nagaraja D, Veerendrakumar M, Jayaram M, Jayakumar PN. Stroke in the posterior circulation territory- A clinical and radiological study. JAPI. 1995;43(12):910.
  11. 1 Jones. H. Royden, Clark. H Millikan, Burton. A. Sandok, Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction; Stroke, 1980,11(2): 173-177.
  12. Richard A.L., Macdonell, Renate. M. Kalnins et al: cerebellar infarction:Natural history, prognosis and pathology, Stroke, 1987, 18(5): 849-855.
  13. Cristina L., Isagani Jodi G. de los Santos; posterior circulation stroke, Philippine heart center, 2001,4 (http://www.phc.gov.ph/cgi-bin/ res_complete.cgi)
  14. B. Libman, T.G.Kwiatkowski, M.D. Hansen et al; Differences between Anterior and Posterior Circulation Stroke in TOAST, Cerebrovascular Diseases, 2001; 11: 311-316
  15. Sundar U, Mehetre R. Etiopathogenesis and Predators of In-Hospital Morbidity and Mortality in Posterior Circulation Strokes – A 2 Year Registry with Concordant Comparison with Anterior Circulation Strokes. JAPI. 2007;55;846-50.
  16. Caplan LR, Wityk RJ, Pazdera L, Chang H-M, Pessin MS, DeWitt LD. New England Medical Centre Posterior Circulation Stroke registry II, Vascular Lesions. J Clin Neurol. 2005;1(1):31-49.
  17. Rawat KJ, Korde BS, Joshi KS. Clinical profile and prognosis of patients with posterior circulation stroke. Int J Res Med Sci 2016;4:5159-64.
  18. Kora SA, Doddamani GB. Clinical Profile of Posterior Circulation Stroke In A Tertiary Care Centre In Southern India Journal of Clinical and Diagnostic Research. 2011;5(2):217-21.
  19. Portenoy RK, Abissi CJ, Lipton RB, Berger AR, Mebler MF, Baglivo J, et al. Headache in cerebrovascular disease. Stroke. 1985;15(6):100912.
  20. K.B., Manuel Ramirez and Bruce. D.Snyder; Temporal profile of vertebrobasilar territory infarction, Stroke, 1980,11(6): 643-648.
  21. Bogousslavsky. J, F. Regli, Maeder, R. Meuli et al; The etiology of posterior circulation infarcts; Neurology, 1993, 43: 1528-1533

Corresponding Author

Bibhu P. Behera

Assistant Professor in Medicine, Department of Internal Medicine, Saheed Laxman Naik Medical College & Hospital, Koraput, Odisha

Permanent Address: - Plot no: - 554/1970, Shreevihar, Patia, Chandrasekharpur, Bhubaneswar,

Khurda, Odisha, PIN- 751024, India