Stroke

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Historical Perspective

• Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden paralysis.
• Apoplexy, from the Greek word meaning "struck down with violence,” first appeared in Hippocratic writings to describe this phenomenon.
• The word stroke was used as a synonym for apoplectic seizure as early as 1599, and is a fairly literal translation of the Greek term.
• In 1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause of hemorrhagic stroke when he suggested that people who had died of apoplexy had bleeding in their brains.
• Wepfer also identified the main arteries supplying the brain, the vertebral and carotid arteries, and identified the cause of ischemic stroke when he suggested that apoplexy might be caused by a blockage to those vessels.

Epidemiology

Stroke in USA

• Stroke is a leading cause of serious long-term disability
• In USA, the incidence and mortality rates of stroke has significantly decreased compared to previous years.
• From year 2003 to 2013, the mortality rates due to stroke declined by 18.5%.
• In 2013, stroke became the fifth leading cause of death.
• The case fatality rate of stroke is estimated to be 41.7 deaths per 100, 000 population
• The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.
• It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.
• About 87% of all strokes are ischemic strokes
• Stroke costs the United States an estimated $34 billion each year

Worldwide

• According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide..
• Out of these, 5 million die and 5 million are left permanently disbaled..

Demographics

Age

• Stroke can occur in all age groups. However, the incidence of stroke is less among individuals age less than 40 years of age and the risk increases with increasing age.
• According to WHO, stroke also occurs in about 8% of children with sickle cell disease..
• In 2009, 34% of people hospitalized for stroke were younger than 65 years
• The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%.

The rate of decline in mortality rates of stroke in different age groups is as follows:

• >65 years of age: from 534.1 to 245.2 per 100,000
• 45-65 years of age: from 43.5 to 20.2 per 100,000
• 18 to 44 years of age: from from 3.7 to 2.0 per 100,000

Gender

There is increased incidence of stroke in men as compared to women.

Race

• The risk of incidence of first stroke is twice in african american population as compared to whites with increased mortality rates.
• Hispanics’ risk for stroke falls between that of whites and blacks

Geographical distribution

• There is increased incidence and mortality rates of stroke in developing countries as compared to developed countries due to low socio economic status and heath facilites.
• In USA, the highest death rates from stroke are in the southeastern United States.