Epidemiology and Pathophysiology of Intracranial Large Artery Stenosis

Mohammad, Yousef; Qattan, Marwan

doi:10.2174/1876506801003010003

Cited by 4 publications

(4 citation statements)

References 39 publications

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“…Although malaria is endemic in Cameroon, there was no stroke related to malaria as David Celemerger et al have reported [9].…”

Section: Discussionmentioning

confidence: 96%

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

B¹,

Jc²,

Ntone³

et al. 2016

J Vasc Med Surg

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The prevalence and incidence of cardiovascular disease have been increasing in sub Saharan Africa for the last past twenty years. One of the most common manifestations of cardiovascular disease is stroke. Very few studies have addressed the major causes of ischemic stroke in this region. The objective of this study was to determine the prevalence of significant extra cranial carotid stenosis in a population of patients with acute ischemic stroke. Patients and methods:we conducted a prospective study at the University Hospital Centre of Yaoundé from January 2013 to October 2013. We included all consenting patients with acute onset of neurological deficit with a CT scan of the head showing an ischemic stroke. We excluded all patients with hemorrhagic stroke on CT scan, or who did not have a head CT scan. The study was approved by the National ethics committee.Results: During that period, 35 patients met the criteria for acute ischemic stroke from which 51.4% were women with a sex ratio of 0.94. The mean age in this series was 66.6 years. Thirty five patients over 76 had an ischemic stroke on the CT scan, with a prevalence of 46%. Hypertension was present in 21 (60%) cases and it was a major risk factor. Only 3 patients had a carotid stenosis between 50-75%, there was no patient with a stenosis above 75%. Elevated cholesterol was found in 3.3% of patients while 30 (86%) patients had an abnormal electrocardiogram: 9 patients were found to have a tachyarrhythmia and 6 atrial fibrillation. There was no intracardiac clot even though the echocardiogram was abnormal in 26 (77%) patients. Concerning the CT scan of the head results, hypo densities were found in 26 (74.3%) patients and the CT was normal in 9 (9.9%) patients with a sudden neurological deficit. Conclusion:From this pilot study, we have found that carotid stenosis in association with hypercholesterolemia and arteriosclerosis may not be a major risk factor for ischemic stroke in our environment, while age, hypertension and arrhythmia are the most important risk factors for this disease in Cameroon. Further and larger study is needed to confirm this preliminary finding.

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“…Although malaria is endemic in Cameroon, there was no stroke related to malaria as David Celemerger et al have reported [9].…”

Section: Discussionmentioning

confidence: 96%

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

B¹,

Jc²,

Ntone³

et al. 2016

J Vasc Med Surg

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“…In fact, the impact of hypertension as a risk factor for intracranial atherosclerosis was already established from autopsy studies. Based on epidemiological studies, hypertension is associated with increased odds for the development of intracranial stenosis that ranged from 5 to 9.7 12 . Moreover, the risk further increased when hypertension was associated with other risk factors.…”

Section: Risk Factors For Strokementioning

confidence: 99%

“…Ischaemic heart disease was found in 34%, diabetes mellitus in 26%, dyslipidaemia in 30%, atrial fibrillation in 25%, carotid artery stenosis in 27% 11 . 15% patients were obese and family history of stroke was 12% 12 . They concluded that cerebral infarction accounts for 80 to 85% cases of stroke 8 .…”

Section: Modifiable Risk Factorsmentioning

confidence: 99%

Modifiable and Non-Modifiable Risk Factors of Stroke: A Review Update

Choudhury

Chowdhury

Nayeem

et al. 2015

J. Natl Inst. Neurosci Bangladesh

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Stroke is the third most common cause of death in industrialized countries. Stroke is the most important cause of morbidity and longterm disability in Europe as well as in other industrialized nations. Prevalence rate was higher among men compared with women 3.44 and 2.41 per 1000 respectively. Data from the Northern Manhattan study showed the age adjusted incidence of first ischemic stroke per 100,000 was 88 in Whites 191 in Blacks and 149 in Hispanics. Black has almost thrice the risk of first ever stroke compared with Whites. The age adjustment stroke incidence rates for first ever stroke are 167 for White males, 138 for White females, 323 for Black males and 260 for Black females. Among American-Indian age 65-74, the annual rates per 1,000 population of new and recurrent stoke are 6.1 for men and 6.6 for women. 22The prevalence of stroke in American Indian mean age 45-74 ranges from 0.2 to 1.4 percent and in women from 0.2 to 0.7 percent 5 . In a study in Bangladesh the prevalence rate of stroke were 2.0, 3.0, 2.0, 10.0 , and 10.0 per 1000 within age groups of 40 -49 years, 50-59 years, 60-69 years, 70-79 years and 80 years to above age group respectively 6 . Prevalence rate rose with age. People with age range 70-79 years compared to 40-49 years age range is 4.98 times and people with age range > 80 years compared to 40-49 years age range is 4.78 times more likely to have suffered from stroke. Prevalence rate was higher among men compared with women 3.44 and 2.41 per 1000 respectively 7 . On average every 45 seconds someone in the United States has a stroke. Each year about 700,000 people experience a new or current stroke 5 . About 500,000 of these are first attack and 200,000 are recurrent attacks 4 . Each year about 46,000 more men than women have a stroke 6 . Men's stroke incidence rate is 1.25 times greater than women's 6 .

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“…Stroke due to intracranial atherosclerotic disease is caused by hemodynamic failure, in-situ thrombus from plaque disruption, and/or distal thromboembolism. 11 Secondary hypertension due to intracranial atherosclerotic disease is a common compensatory mechanism to maintain adequate cerebral perfusion.…”

Section: Rawal Et Almentioning

confidence: 99%

Intracranial Hemorrhage Due to Secondary Hypertension from Intracranial Large Vessel Occlusion

Rawal

Waldman

Saeed

et al. 2020

Clinical Practice and Cases in Emergency Medicine

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Simultaneous hemorrhagic and ischemic strokes have been previously reported in the literature. Typically, these occur in patients secondary to dialysis, cerebral amyloid angiopathy, or thrombotic thrombocytopenic purpura.1,2,3 However, this is the unique case of a 62-year-old Asian female who presented with a hemorrhagic stroke suspected to be secondary to refractory hypertension from intracranial large vessel atherosclerotic flow limiting stenosis, with rapid subsequent large vessel occlusion and ischemic stroke. Questions arise such as ideal blood pressure parameters for dual management, timeliness of computed tomography angiography imaging in the emergency department for detection of large vessel occlusion during intracranial hemorrhage, and subsequent selection of treatment plan in the dual-lesion patient population.

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Epidemiology and Pathophysiology of Intracranial Large Artery Stenosis

Cited by 4 publications

References 39 publications

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

Modifiable and Non-Modifiable Risk Factors of Stroke: A Review Update

Intracranial Hemorrhage Due to Secondary Hypertension from Intracranial Large Vessel Occlusion

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