Stroke Epidemiology

Stroke[1] is a death of brain cells caused by vascular etiology with clinical symptoms (Cerebral Vascular Accident) or without the presence of clinical signs (Transient Ischemic Attack). There are two types of stroke[2] [3]: 1) Ischaemic Stroke; where obstruction of blood supply to the brain causes hypoxia and hypoglycemia, which leads to the death of brain tissues[4], 2) Hemorrhagic Stroke; where the hematoma in the head causes compression of brain cells resulting in injury and death of brain cells. The immediate signs and symptoms of stroke include sudden weakness or numbness to one side of extremity or face, confusion, trouble speaking, impaired vision, loss of balance, incoordination, severe headache for no reason. Sudden is the keyword in all of these symptoms.

Stroke incidence is an emergency because people can die if the medical intervention is not provided fast enough. Also, the faster the intervention less is the effect of stroke on the body.

Remember F.A.S.T.E.R[5] when you witness a stroke incidence.

F: Face drooping/numbness on one side.

A: Arm getting more numb/weak than the other side.

S: Stability loss; unable to stand or difficulty in balance.

T: Talking difficulty; slurred speech or unable to speak.

E: Eyes; impaired vision.

R: React; a reminder to call 911.

Incidence

EventU.S.A./yearWorld/year
Stroke (New + Recurrent)795,00015 million
New stroke610,00013.7 million
Recurrent stroke185,0001.3 million
Death from stroke140,0005.52 million
Men380,0008 million
Women425,0007 million
0-44 age group80,0001.5 million
45 and above705,00013.5 million
Sources[6] [7] [8] [9] [10]

It is interesting to note that in the U.S., women are prone to stroke more than men, while in the rest of the world, men are prone to stroke more than women.

Classification of Stroke[11] [12]

Liability factors[i]

Age

Age is the most important natural determinant factor of all. In the age group 45 years and above, the chances of stroke is about 13 times more than the rest age group.

Medical Condition

Hypertension is the leading medical factor that contributes to Stroke onset. Diabetes, high LDL cholesterol, carotid artery disease, heart disease, bleeding disorders, sleep apnea, sickle cell disease, kidney disease, and Covid 19 are other factors after hypertension.

Lifestyle Habits

Smoking, alcohol consumption, high-stress level, physical inactivity, illegal drug intake, overweight, and unhealthy food lay a role in stroke onset.

Race

The white race has a lesser chance of stroke than the other group.

Family History

People with a family history of stroke are at higher risk.

Genetic

People with blood type A.B. have a higher risk.

[i] 6. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018:3238165. Published 2018 November 27. doi:10.1155/2018/3238165

Consequences of Stroke[14] [15]

Effects of stroke in the right cerebrum

  • Left-sided paralysis or weakness. It is the most common effect of stroke.
  • Weak or no grip strength and pinch strength in hand.
  • Impaired fine motor coordination or eye-hand coordination.
  • May have a sensory impairment.
  • May have unilateral neglect. Or left neglect.
  • Diminished left peripheral vision.
  • Impaired spatial problems with depth perception. It may be difficult for the client to ambulate on an un-even surface or reach out for the target object with a hand.
  • Inability to localize or recognize body parts.
  • Inability to understand maps and find objects, such as clothing or toiletry items.
  • Impaired cognitive (thinking, reasoning, judgment, and memory) ability.
  • Impaired perception.
  • Impaired self-care ability, particularly for the tasks that require bilateral use of hands. Persons with the dominant left hand feel more disabled.
  • Behavioral changes, such as impulsivity, inappropriateness, and depression.

Effects of stroke in the left cerebrum

  • Right-sided paralysis or weakness. It is the most common effect of stroke.
  • Weak or no grip strength and pinch strength in hand.
  • Impaired fine motor coordination or eye-hand coordination.
  • May have a sensory impairment.
  • Problems with speech and understanding language (aphasia).
  • Diminished right peripheral vision.
  • Impaired ability to do math or to organize, reason, and analyze items.
  • Behavioral changes, such as depression, cautiousness, and hesitancy.
  • Impaired ability to read, write, and learn new information.
  • Impaired cognitive (thinking, reasoning, judgment, and memory) ability.
  • Impaired perception.
  • Impaired self-care ability, particularly for the tasks that require bilateral use of hands. Persons with the dominant right hand feel more disabled.

Effects of stroke in the cerebellum

  • Inability to walk in-coordination and imbalance (ataxia)
  • Dizziness
  • Nausea and vomiting

Complications of stroke[16] [17]

 The most common complications of stroke are:

  • Shoulder subluxation; is a partial shoulder dislocation because of very weak muscles around the shoulder joint that can not hold the humerus ball intact into the socket against the arm’s constant gravitational pull in the downward direction.
    • Shoulder- hand syndrome -It is a painful syndrome in the upper extremity. The main signs and symptoms include pain and considerable movement reduction in the shoulder joint, wrist, and hand.
    • Contracture in extremity joints, especially in the finger joints.
    • Shoulder pain – Pain results from joint stiffness and very weak muscles around the shoulder joint that can not hold the humerus ball intact into the socket against the arm’s constant gravitational pull in the downward direction.
    • Deep venous thrombosis (DVT) – Lack of mobility in the extremity may contribute to the blood clot.
    • Pusher Syndrome – Patients tend to push towards the hemiplegic side. It is more common in right hemisphere stroke.
    • Urinary tract infection (U.T.I.) – U.T.I. can occur due to incontinence.
    • Seizures – More common in severe cases.
    • Emotional aloofness and depression; This could be because of a new disability.
    • Bedsores – pressure ulcers due to lack of mobility to change the position frequently.
    • Disability. Depending on the severity of a stroke and its management, a person may have various degrees of disability.

References


[1] Sacco R. L., Kasner S. E., Broderick J. P., 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):2064–2089.doi: 10.1161/STR.0b013e318296aeca.

[2] Bamford J., Sandercock P., Dennis M., Burn J., Warlow C. Classification and natural history of clinical identifiable subtypes of cerebral infarction. The Lancet. 1991;337(8756):1521–1526. doi: 10.1016/0140-6736(91)93206-o.

[3] 6. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018:3238165. Published 2018 November 27. doi:10.1155/2018/3238165

[4] Ojagbemi A, Akpa O, Elugbadebo F, Owolabi M, Ovbiagele B. Depression after Stroke in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Behav Neurol. 2017;2017:4160259. doi:10.1155/2017/4160259

[5] Health, Beaumont. “Stroke Symptoms: From FAST to FASTER.” Beaumont Health. Beaumont Health.

[6] Moran A., Forouzanfar M., Sampson U., Chugh S., Feigin V., Mensah G. The epidemiology of cardiovascular diseases in sub-Saharan Africa: the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Progress in Cardiovascular Diseases. 2013;56(3):234–239. doi: 10.1016/j.pcad.2013.09.019.

[7] Go, A., Mozaffarin, D., Roger, V. L., Benjamin, E., Berry, J. D., Borden, W., …Turner, M. (2013). Heart disease and stroke statistics 2013 update. Circulation, 127, e6–e245.

[8] Sacco R. L., Kasner S. E., Broderick J. P., 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):2064–2089.doi: 10.1161/STR.0b013e318296aeca.

[9] Ovbiagele B, Nguyen-Huynh MN. Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics. 2011;8(3):319-329. doi:10.1007/s13311-011-0053-1

[10] “Stroke Facts.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, September 08 2020.

[11] Adams H. P., Jr., Bendixen B. H., Kappelle L. J., et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke. 1993;24(1):35–41. doi: 10.1161/01.STR.24.1.35

[12] 4.  Bamford J., Sandercock P., Dennis M., Burn J., Warlow C. Classification and natural history of clinical identifiable subtypes of cerebral infarction. The Lancet. 1991;337(8756):1521–1526. doi: 10.1016/0140-6736(91)93206-o.

[13] 6. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018:3238165. Published 2018 November 27. doi:10.1155/2018/3238165

[14] 11. Effects of Stroke. Johns Hopkins Medicine.

[15] 7. Caplan L. R. Caplan’s Stroke: A Clinical Approach. 3rd. Woburn, England: 2000.

[16] 12. Zyluk A, Zyluk B. Zespół bark-reka u chorych po udarze mózgu [Shoulder-hand syndrome in patients after stroke]. Neurol Neurochir Pol. 1999 Jan-Feb;33(1):131-42. Polish. PMID: 10399731.

[17] 5. Donkor E.S. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;2018:3238165. Published 2018 November 27. doi:10.1155/2018/3238165

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