The modifiable risk factors for cerebrovascular disease are hypertension, Smoking, diabetes mellitus, diet (high salt &fact, low potassium & vitamins) excess alcohol intake, morbid obesity, low physical exercise, cholesterol concentration, low temperature etc.

Stroke is a worldwide health problem. It makes an important contribution to morbidity and disability in developed as well as developing countries. Although there are substantial differences in frequency from place to place, cerebral thrombosis is usually the most frequent from of stroke encountered in clinical studies, followed by haemorrhage. Subarachnoid haemorrhage and cerebral embolism come next as regards both mortality and morbidity (I). However, stroke from cerebral haemorrhage is more common in Japan than elsewhere (2)

As very few reports of such studies are available and in 1957 a study group of World Health Organization (W.H.O.) has expressed the view that in order to get a comprehensive picture of disease, more and more studies have to be carried out, Garg Narendra K. (3). This prompted the authors to undertake this Epidemiological study of cerebrovascular patients admitted in a tertiary hospital.

MATERIAL AND METHODS:

A study of 50 patients of both sexes and all age groups with “cerebrovascular accident” diagnosed by CT scan was done. Patients were taken from the neurology wards of J.A. Group of Hospitals, Gwalior (M.P.) with positive CT finding. Detailed neurological as well as other systemic examination of the patients was done with special attention to the symptoms like Headache, Vomiting, Consciousness, Speech and Visual Disturbances, Weakness, Convulsion, Fever etc.

A special note was made of presence or absence of pre-existing or co-existing disease like hypertension, diabetes mellitus, cardiac illness, tuberculosis, syphilis, accidents/operations, previous episode of cerebrovascular accident and other chronic medical ailments.

Hb estimation, blood sugar, urine sugar, electro cardio gram, X-ray chest, was done in relevant cases.

Data were collected in a pre-drawn and pre-tested proforma.

RESULTS:

14 Patients comprising 28% total were in are group of 51-60 years. Majority of male patients were in 41-50 and 61-70 years age group (9 patients in each group) followed by 8, 4, 1 respectively in 51-60, 71-80 and 31-40. Maximum of female patients were (6 patients) in age group of 51-60 years followed by 4,3,2,1 respectively in 31-40, 61-70, 41-50 and 71-80 years of age (Table - I). It is interesting to note that 3 male patients belong to 81 and above years of age group in comparison to none in their counterparts i.e. females.

Table – I: Age and Sex wise distribution of 50 cases of cerebrovascular accidents.

Age in Year	Male	Female	No. of Cases	Percentage
31-40	1	4	5	10
41-50	9	2	11	22
51-60	8	6	14	28
61-70	9	3	12	24
71-80	4	1	5	10
81 and above	3	0	3	6

Out of 50, 30 patients comprising 60% of total were from the rural background, while 20 patients (40%) were the urban background. On computed tomogram out of 50 cases, 30 showed hemorrhagic lesions including 1 case showed hemorrhagic as well as ischemic lesion and 20 showed only ischemic lesion (Table - II).

Table – II: Distribution of patients with cerebrovascular accident according to rural-urbn distribution.

Rural-urban Distribution	Hemorrhagic	Ischemic	No. of Cases
Rural	18	12	30
Urban	10	10	20

35 patients (70%) were presented with symptom of disturbed consciousness 15 patients had weakness and 14 patients had speech loss followed by fever, headache, vomiting, convulsion and vision loss respectively in 7, 5, 4, 4 and 1 patient (Table - III).

Table – III: The presenting symptoms of patients with cerebrovascular accident

Symptoms	No. of Cases
Headache	5
Vomiting	4
Unconsciousness	35
Speech loss	14
Vision loss	1
Weakness	15
Convulsion	4
Fever	7

Motor weakness was present in all 15 conscious patients. Presenting sign of disturbed consciousness seen in 35 patients, 7^th cranial nerve involvement as a facial palsy seen in 19 patients. Blood pressure was elevated in 31 patients at the time of examination (Table - IV).

Table – IV: The presenting signs and neurological deficit in patients with cerebrovascular accident

Presenting Signs and Neurological deficit	No. of Cases
Motor Weakness	15
Disturbed cognitive function	35
Cranial nerve involvement	19
Blood pressure	31

Out of 50 cases, 22 had past history of hypertension, 2 had diabetes mellitus, 5 had cardiac lesion (2 RHD, 3 MI). Tuberculosis and malaria associated with 1 case each. Past history of cerebrovascular accident was noted in 5 cases (Table - V).

Table – V: The Associated diseases of patients with cerebrovascular accident

Associated diseases	No. of cases
Hypertension	22
Diabetes mellitus	2
Cardiac lesions (RHD/MI)	5
Tuberculosis/Malaria	2
Past H/O cerebrovascular accident	5

DISCUSSIONS:

In this study 50 patients with cerebrovascular accident were divided into 6 age groups. 14 patients in age group of 51-60 years. However majority of male patients were seen in age group of 41-50 and 61-70 years, 9 patients in each group, while maximum 6 female patients were seen in age group of 51-60 years. 5 patients (1%) were in age group of 31-40 years, another 5 patients (10%) were in age group of 71-80 years, 11 cases (22%) were in age group of 61-70 years. In 80 years and above age group only male 3 cases (6%) were seen, among those only one was above the 90 years.

Park K. (4) Stroke can occur at any age. Usually incidence rates rise steeply with age. In developed countries, over 80 percent of all stroke deaths occur in persons over 65 years. In India, about one-fifth of all strokes occur below the age of 40 (called “stroke in young”). This is attributed to our “young population” and shorter life expectancy (about 55 years). The incidence rates are higher in males than females at all ages, which is more or less similar to the findings of the present study.

Out of 50 patients, 30 patients (40%) were from the urban background. Regarding the presenting symptoms, 35 patients (70%) presented with disturbed consciousness, 15 (30%) presented with weakness in limbs, 14 (28%) presented with speech loss, 5 patients had headache, amongst those 3 were hypertensive and 2 were normotensive patients, 1 was a case of cerebral malaria and had multiple intra cranial hemorrhages, 7 patients had fever, 4 patients had vomiting, 4 patients had convulsion and only one presented with vision loss. In majority of patients more than one symptoms were present.

The presenting sign of motor weakness was present in all 50 cases, although it could not be elicited properly unconscious patients. 35 cases comprising 70% of total had presenting sign of disturbed consciousness, 19 patients had 7^th cranial nerve involvement and presented with facial palsy.

Elevated blood pressure was found in 31 cases at the time of examination. Elevated blood pressure was included if systolic blood pressure more than 160 mmHg of diastolic blood pressure more than 90 mmHg. Out of 31 cases 22 (70%) were known cases of hypertension.

Cerebrovascular accident is often associated with other systemic diseases. In our study out of 50, 22 cases had past history of hypertension. Among the 22 cases, 11 had hemorrhagic cerebrovascular accident, 4 had ischemic cerebrovascular accident, while 1 had both hemorrhagic as well as ischemic events, 2 patients had past history of diabetes mellitus as well as hypertension, among those one suffered from hemorrhagic event, another one from ischemic event. 5 cases comprising 10% of total had past history of cerebrovascular accident. Out of 50, 5 cases (10%) had past history of cardiac lesion, as diagnosed by echocardiogram and electrocardiogram, 2 cases of chronic rheumatic heart disease and 3 cases of myocardial infarction, 4 cases were presented with ischemic accident, while one presented with hemorrhagic accident. Out of 50, 1 was known case of pulmonary tuberculosis, under anti Koch’s medication since 6 months, at the time of ischemic episode. 1 case had cerebral malaria presented with multiple intra cranial hemorrhage. The possible cause was leptomeningeal arteritis.

W.H.O. (2) showed that nearly three-quarters of all registered stroke patients had associated disease, mostly in the cardiovascular system or of diabetes. This supports the view that in most cases stroke is merely an incident in the slowly progressive course of a generalized vascular disease. The findings of the present study were more or less in accordance of the findings of the various studies carried out by different researchers throughout the Globe.

A WHO collaborative study in 12 countries (2)showed that in populations studied, stroke incidence rates ranged from 0.2 – 2.5 / 1000 population / year, the variation being mainly due to differences in the age structure of the population involved. Standardized rates for age in men were 2 /1000 population in Colombo, capital of Sri Lanka, 4 – 8 in most European countries, but in Akita of Japan, females rates were on an average 30 % lower. The highest morbidity figures come from Japan. The cerebrovascular accident is common and likely to be fatal or cause serious disability (Kennedy R Lees et al (5). A second accident will not necessarily be of the same type as the initial event, although hemorrhages tend to recur. Patient with previous cerebrovascular accident commonly succumb to other vascular events, in particular myocardial infarction. Effective secondary prevention depends on giving attention to all modifiable risk factors for cerebrovascular disease as well as treating the causes of the initial event.

For preventive measures, the authors reached to the conclusion that though the present efforts are able to bring awareness among the masses about various aspects of Cerebrovascular diseases, but still there is a wide gap between the knowledge and practices of the people which is a matter of real concern, so every efforts must be made to bridge this gap i.e. to make aware the people about various aspects of the cerebrovascular accidents and put that knowledge in to their practices. This is possible among other things by (i) unearthing the hinderance i.e. by conducting K.A.P. studies. The findings of these studies will act as pegs on which to hang new knowledge. These findings must be disseminated in the community. The most common source for dissemination , now a days is Television.T.V.is an audio visual media and can easily exploited to reach certain target groups for education and will be more effective if our health education messages will be telecast with a bit entertainment touch. So proper and wise use of media mix i.e. T.V., Radio, Print media, Cinemas etc. may be helpful in strengthening the I.E.C. campaign for not only enriching the knowledge of the people but also motivate them to bring that scientific knowledge in to their behavior. (ii) By strengthening the Democratic alliances between the key players i.e. the patient, people around them and the service providers about health matters. So all these three freely frankly exchange their views about fears, concerns, prejudices, and problems and not only seek help but also extend their help in whatever form, where and when ever desired. Cerebrovascular disease diagnostic, treatment and education camps are one of the best means for operationalising this strategy. These camps are to be organized by local people using medico technical skills of health service providers. The community contributes to facilitate the camps by providing venue and volunteers as well by publishing the events in the nearby community. In these camps undiagnosed cases come forward. These approaches also help to in early detection of cases. These camps provide best opportunity for counseling and can be organized at low cost and also do not need extra funding Bansal A.K.at al (16). In summary, the control of stroke that was once considered an inevitable accompaniment to aging is now being approached through primary prevention. It has generated the hope that stroke can be tackled by community health action.

ACKNOWLEDGEMENT:

The Authors expresses their sincere thanks to Shri. Anand Singh Kanwar, Lab-Technician, Dept. of Community Medicine, Govt. Medical College, Jagdalpur for his efficient typing without his help this paper could not come in this form.

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Received on 24.04.2011

Accepted on 12.07.2011

Research J. Pharmacology and Pharmacodynamics. 3(4): July –August, 2011, 192-195