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J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1640-7. doi: 10.1016/j.jstrokecerebrovasdis.2014.01.009. Epub 2014 Apr 6.

Ischemic strokes in Pakistan: observations from the national acute ischemic stroke database.

Author information

1
Department of Neurology (Medicine), Aga Khan University, Karachi, Pakistan.
2
Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
3
Liaquat National Hospital, Karachi, Pakistan.
4
Shaheed Benazir Bhutto Medical University, Larkana, Pakistan.
5
Department of Neurology (Medicine), Aga Khan University, Karachi, Pakistan. Electronic address: mohammad.wasay@aku.edu.

Abstract

BACKGROUND:

The objective of this study was to establish a multicenter ischemic stroke registry, first of its kind in Pakistan, to provide insight into the epidemiology, subtypes, and risk factors of ischemic strokes in this country.

METHODS:

Four academic centers (3 urban and 1 rural) participated in this project. The inclusion criteria for subjects included adults (>14 years) with acute neurologic deficit, consistent with clinical diagnosis of ischemic stroke and supported by neuroimaging.

RESULTS:

Data were available for 874 subjects. Mean age of the subjects was 59.7 years, 60.5% were males, and 18% were young. Large vessel strokes were the most common subtype found in 31.7% subjects, followed by small vessel disease (25.7%) and cardioembolic strokes (10.4%). Almost 32% subjects had ill-defined etiology for their ischemic stroke. Dyslipidemia was a most common risk factor present in 83% patients. Data related to in-hospital complications were available for 808 subjects, of which 233 complications were recorded. Pneumonia was the most common of these seen in 105 (13%) subjects, followed by urinary tract infection (7.2%). Outcome at discharge was recorded for 697 subjects. Ninety-two had died during their hospital stay (13.2%). Only 36% subjects had a favorable outcome at discharge defined as a modified Rankin Scale (mRS) score of 2 or less. A total of 446 of 697 subjects had poor outcome at discharge (defined as an mRS score≥3).

CONCLUSIONS:

Hypertension and dyslipidemia were the most common risk factors and large vessel atherosclerosis was the most common stroke etiology. Elderly patients were significantly more likely to have in-hospital complications, die during their hospital stay, and have a higher mRS score at discharge.

KEYWORDS:

Pakistan; Stroke; ischemic; outcome; south Asia

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