Stroke = “brain attack” =
Rapid onset of focal (or at times global) cerebral deficit, lasting at least 24 hours (or leading to earlier death), and for which there is no cause other than a vascular one
3 main pathological types
• ~ 80% ischaemic
• ~ 15% primary intracerebral haemorrhage
• ~ 5% subarachnoid haemorrhage
• “Mini stroke”
• Definition as for stroke except lasts < 24 hours (and not fatal)
• Vast majority are ischaemic
TIA (transient ischaemic attack) = “brain attack” =
Causes of death worldwide in 1990: WHO /
World BankGlobal Burden of Disease Study
Millions
All causes 50.5
Coronary heart disease 6.3 (12% of total)
Cancer (all types) 6.1 (12% of total)
Cerebrovascular disease 4.4 (9% of total)
Global burden of stroke - mortality
• 4.4 million deaths worldwide in 1990
• 2/3 of these deaths in developing countries
• Stroke deaths likely to double by 2020
• 3rd commonest cause of death after coronary heart disease and cancer
• Mortality data do not tell the whole story, since most strokes are not fatal
• Major burden of stroke is chronic disability
Incidence of first-ever-in-a-lifetime stroke in the Oxfordshire Community Stroke Project
(Bamford et al 1990)
Cumulative percentage of first-ever-in-a-lifetime strokes by age in the Oxfordshire
Community Stroke Project, 1981-1984
years
Three quarters of the strokes occur in > 65 year olds
Half the strokes occur in > 75 year olds
Age and sex standardised annual incidenceof stroke, age 45 to 84 years, in 10 ‘ideal’
community- based studies in the 1980s and 1990s (Sudlow and Warlow 1997)
Stroke in the UKpopulation ~ 60 million
• 125,000 strokes each year
• GP (list = 2000) would see ~ 4 per year
• 250,000 disabled stroke survivors
• GP would have ~ 7 such patients on list
Outcome after a stroke
Describing the effects on an patient:
• (Death)
• WHO classification:
Impairment
Disability
Handicap
Outcome after a stroke
• About 20% will die within one month
• By one year over half will be either dead (30%) or dependent (25%)
• After a 1st stroke, 10% will have another stroke in the first year, and 5% per year thereafter
• Also at risk of serious vascular disease elsewhere. About half eventually die of coronary heart disease
% of patients with different outcomes one year after first-ever stroke
(Oxfordshire Community Stroke Project, n = 675)
0
20
40
60
80
100
All types PICH SAH Ischaemicstroke
%
Independent
Dependent
Dead