Lecture 23 - Stroke

Babylon University – College Of Medicine
Department of Community Medicine

Lectures in Community Medicine
For 4th Stage Students
By Dr. Hassan Baiee
2011 – 2012

Lecture 23
Stroke

The term stroke is applied to acute sever manifestation of cerebrovascular disease.
Definition: rapidly developed clinical signs of focal disturbance of cerebral function.
Lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin.

Clinical classifications:
1- Subarachnoid hemorrhage.
2- Cerebral hemorrhage.
3- Cerebral thrombosis.
4- occulation of pre cerebral arteries.
5- Transient cerebral ischemia more than 24 hours.

Transient ischemic attack:
Episodes of focal, reversible, neurological deficit of sudden onset and of less than 24 hours duration, shows tendency for recurrence.

Extent of the problem:
• Cerebral thrombosis most common followed by cerebral hemorrhage.
• Nearly 75% of stroke patients had associated cardiovascular disease or diabetes. The incidence ranges from 0.2 – 2.5 / 1000 population.
• It is the leading cause of mortality, one third of stroke patients die within three weeks and 48% die within one year.
• Mortality shows declining trend in developed country.


Non-modifiable risk factors of stroke:
• Age: increases with age
• Gender: more in males.
• Race: more in African and Asian than in European people.
• Heredity: there is a positive family history which associated with this disease.


Modifiable risk factors of stroke:
• Hypertension
• Heart disease
• Diabetes
• Hyperlipidaemia
• Smoking
• Access alcohol
• Polycythaemia
• Oral contraceptives


Prevention of stroke:
• Primary Prevention:
Primary prevention by health education (population strategy is the most ideal) and
A- Elimination of smoking
B- Controlling other risk factors like diabetes
C- Low fat diet
D- Avoidance of alcohol consumption or reducing intake to the minimum amount < 75 gm per day.


• Secondary prevention:
1- Early detection of risk factors.
2- Treatment (which may be long term) with appropriate medications.
3- Long term follow up especially those with transient ischemic attacks (aspirin).
4- Appropriate neurological management.

• Tertiary prevention;
A- Disability limitation
1- Treatment of complications.
2- Good nursing care (bladder and bowel).
3- In developed countries specialized stroke care unit exists.
B- rehabilitation: physical, occupational, psychological
Half to three quarter surviving an acute stroke achieve functional independence mostly within the first three months.