A STUDY OF CLINICAL, AETIOLOGICAL PROFILE AND OUTCOME IN ISCHAEMIC POSTERIOR CIRCULATORY STROKE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 27
Abstract
BACKGROUND The posterior circulation strokes account for 10 to 15% of all strokes. The posterior circulation ischaemia ranges from fluctuating brainstem symptoms caused by intermittent insufficiency (so called VBI) to many syndromes like lateral, medial medullary, total medullary, locked in and top of basilar artery syndrome. Population based studies have shown that in India the annual incidence rates of stroke are 119 - 145 and 84 - 262 in rural and 334 - 424 in urban areas per 100,000 population respectively. The incidence in Indian studies was approximately 12.3%. Basilar Artery Occlusion (BAO) represents 8 to 14% of all posterior circulation strokes and carries mortality of over 90%. The aim of this study was to evaluate the clinical and aetiological profile of ischaemic posterior circulatory stroke and to assess the outcome of ischaemic posterior circulatory stroke. MATERIALS AND METHODS The present descriptive study was conducted in patients attending neurology outpatient department, emergency department of Narayana Medical College, Nellore with acute ischaemic posterior circulation stroke from January 2014 to June 2015. This study included 130 patients of posterior circulation ischaemic stroke. Patients with age > 18 years who presented with signs and symptoms of posterior circulation ischaemic stroke were evaluated by clinical examination and confirmed by imaging, either by CT/ MRI brain were included. Patients with head injury, ICSOL (Intracranial Space Occupying Lesion), haemorrhagic stroke, CVT (Cerebral Venous Thrombosis), SAH (Subarachnoid Haemorrhage), Recurrent Strokes and Anterior Circulation Ischaemic Stroke were excluded. The patients were subjected to routine biochemical investigations including complete haemogram, renal function tests and serum electrolytes, fasting lipid profile, coagulation profile, serum homocysteine, serum APLA (Antiphospholipid Antibody) IgG, IgM, 2D Echocardiography, neck vessel Doppler, imaging of the brain with CT (Computerised Tomography) and MRI (Magnetic Resonance Imaging). MRA (Magnetic Resonance Angiography) study could be done only for few patients, because of financial constraints. The patients were evaluated clinically and monitored during the course of disease. The Stroke Severity (at admission, discharge, 3 months) and outcome at 3 months were assessed with NIHSS (National Institute of Health Stroke Scale). The data values were entered into MS-Excel and statistical analysis was done by using IBM SPSS Version 20.0. For categorical variables, the data values were represented as number and percentages. RESULTS Posterior Circulation Ischaemic Stroke was predominantly noted in males (61%) when compared to females. Mean age of patients was 59.81 +/- 11.55 years. Hypertension (84.6%) was the leading modifiable risk factor followed by diabetes mellitus (33.1%). The most common clinical feature is vertigo/giddiness (48.5%). Large vessel atherosclerosis (84.6%) was the most common aetiology observed followed by cardioembolic stroke of other determined aetiology and small vessel disease. The mortality was observed in 6 patients out of 130 patients due to raised intracranial tension with consequent herniation of the cerebellum. CONCLUSION Posterior circulation stroke generally carries a good prognosis depending on infarct location and size except for basilar artery thrombosis, which has a grave prognosis with high mortality.
Authors and Affiliations
Anil Kumar Thatikonda, Abhilash Thatikala, Sriranga Lakshmi Gudivella, Ramesh Ramchandra, Archana Bethala, Sangamithra Gandra
Keywords
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- EP ID EP467174
- DOI 10.14260/jemds/2018/702
- Views 59
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