Study of Stroke in Young Patients at PDU Medical College, Rajkot, Gujarat Gambhir Rahul M 1, Rathod Ketan 2*

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1 ORIGINAL ARTICLE Study of Stroke in Young Patients at PDU Medical College, Rajkot, Gujarat Gambhir Rahul M 1, Rathod Ketan 2* 1 Associate Professor in Medicine, P.D.U. Medical College, Rajkot, 2 Assistant Professor in Radiology, M. P. Shah Medical College, Jamnagar. ABSTRACT BACKGROUND AND OBJECTIVES: Stroke in the young - because of its potential to create a long-term burden on the victims, their families, and the community- is catastrophic even with non- fatal outcome. There had been relatively few studies on young stroke in Gujarat s socio-economic setup. To study the prevalence, patterns and risk factors of young stroke. A retrospective study with case control comparison at PDU Government Medical College Hospital, Rajkot, Gujarat, India. METHODS: Total 100 stroke patients admitted over 2 years were selected and data were collected from case sheets for the purpose. RESULTS: Of 100 stroke patients, 26 had stroke in the young, among which 25(96.15%) had ischemic stroke. DM was the most common risk factor. Valvular heart disease, hypertension, Smoking were found to be more common in cases (young stroke) when compared with controls. CONCLUSION: In all, 26% of total stroke occurred in young adults <50 years. The proportion of ischemic stroke in young adults was higher than in elderly. DM was most common risk factor compare to valvular heart diseases and atrial fibrillation which were more common in few studies of young stroke. Keywords: Young stroke, DM, Valvular heart diseases INTRODUCTION Stroke is a global health problem and a leading cause of adult disability 1. Stroke is the second major cause of death worldwide 2, and the fourth major cause of death in India, the death rate being 0.6/1000 in India 3. Of 35 million deaths attributable to chronic non-communicable diseases that occurred worldwide in 2005, stroke was responsible for 5.7 million (16.6%) deaths, and 87% of these deaths occurred in low- and middle-income countries 2. According to WHO, by 2020, stroke will become the leading cause of both death and disability worldwide, with the number of fatalities projected to over 20 million and by 2030 to over 24 million a year. *Corresponding Author: Dr Ketan Rathod Department of Radiodiagnosis, G.G. Govt. Hospital & Shri M.P. Shah Govt. Medical College, Pandit Nehru Marg, Jamnagar , Gujarat, INDIA Contact No: drketanrathod@gmail.com Although stroke is predominantly a disease of the middle age and the elderly, its occurrence in younger age groups is not rare. It has emerged as an important cause of morbidity and mortality in young adults, especially in developing countries like ours. Stroke in the young is particularly tragic because of its potential to create a long-term burden on the victims, their families, and the community. Also, it results in mortality 4 and a great loss of potential years of their lives. Studies show that in India, 10-15% of the total stroke cases are young stroke. One study done in Kerala, the proportion is 3.8% under the age of 40 and 9.5% under the age of 50 5, however there had been relatively few studies on young stroke in Gujarat s socioeconomic setup. So we tried to find the prevalence, pattern, and risk factors of stroke in the young adults. MATERIALS AND METHODS This is a retrospective study with case control comparison to identify the risk factors of stroke in the young studied among patient admitted between October 2012 to October 2014 in the department of 21 Int J Res Med. 2017; 6(2); e ISSN: p ISSN:

2 Medicine at the PDU Government Medical College Hospital, Rajkot, Gujarat a tertiary referral centre in western India. The study protocol was approved by the Institutional Ethics Committee. 6 All patients admitted with definite diagnosis of stroke during the study period, were retrospectively enrolled. The diagnosis of stroke was established clinically and confirmed by neuroimaging (non-contrast CT head). The study subjects were grouped into cases and controls as per the following demarcation based on age: Case Patients having stroke acquired at less than or equal to 50 years of age with a definite diagnosis of stroke. Control Patients having stroke acquired above 50 years of age with a definite diagnosis of stroke. Information regarding the relevant variables in the study was collected from case sheets. Ward register was used to identify the eligible study subjects. Nonmodifiable risk factors like age, gender, and genetic predisposition and the common modifiable risk factors like hypertension, diabetes mellitus, smoking, alcohol, obesity, coronary artery disease (CAD), transient ischemic attack (TIA), and lack of exercise were noted into 6. Bivariate analysis was done to find the risk factors of young stroke using chi-square test. Definition of Important Study Variables 7-15 Stroke is defined according to WHO criteria as rapidly developing clinical symptoms and/or signs of focal, and at times global, loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin. 7 Young stroke Out of the 26 patients identified as stroke in the young, males have more preponderance compared to stroke in elderly (84.62% versus 77.20%). Table 1 shows socio-demographic characteristics of stroke in the young and table 2 shows comparison with that of elderly. Table 1: Epidemiological and clinical features in young stroke patients Factor Young (Age 50 yrs) Percentage N=26 1 Male Low s/e class High s/e class Diabetes Valvular heart diseases Smoker HBP on admission(>160/ mmhg) 8 Respiratory sys finding CVS finding Alt. RFT RBS (>140) Chest x-ray cardiomegaly Atrial fibrillation on ECG LVH on ECG RVH on ECG VPC on ECG Aortic stenosis on 2D echo Mitral Stenosis on 2D Echo Intracranial haemorrhage Infarct any type mortality Table 2 Comparison of various factors among young ( 50) and old aged patients factor Young (Age 50yrs) N=26 Old (Age>50yrs) N=74 P value Odds ratio 95% CI 1 Male Low s/e class High s/e class Diabetes Valvular heart dis Smoker HBP on adm(>160/90) Chest x-ray cardiomegaly Atrial fibrillation on ECG LVH on ECG RVH on ECG VPC on ECG Aortic stenosis on 2D echo Mitral Stenosis on 2D Echo Hemmorhage Infarct any type mortality Int J Res Med. 2017; 6(2); e ISSN: p ISSN:

3 Risk factors Diabetes mellitus was the most common risk factor in young stroke (53.84%). Valvular heart disease, hypertension, Smoking were found to be more common in cases of young stroke when compared with control [tables 2]. However, only cardiomegaly on x-ray chest was statistically significantly higher among young stroke patients. Out of the diabetic patients 4 also detected having high blood pressure at admission, so % patients have two risk factors. Pattern of young stroke On analyzing the pattern of young stroke, it was found that 96.15% were of ischemic type compared to 72.9% in >50-year-old patients. Young adults showed a more tendency for ischemic stroke than elderly. Other findings On comparing both groups abnormal respiratory system finding were in one (3.84%) young stroke patient compared to 12(16.21%) patients in older group. Abnormal cvs finding in form of varying s1 sound was found in 2 VHD patients in young group while cvs signs were present in four patients in older age group. Significant hypertension B.P. >160/90- was detected in 8(30.76%) young aged patients compared to 13(17.36%) in old patients. DISCUSSION The study gathered information from 100 patients admitted in the medicine wards of PDU Medical College, Rajkot. In this study, 10% were 40 years and 26% aged 50 years, which is slightly more than study published by Praveen et al from Thiruvananthapuram, Kerala, India in In which study 4% of incident strokes occurred in people aged 40 years, 15% occurred in people aged 50 years. This difference may be due to pattern of various modifiable and non-modifiable risk factors in various regions of country. In the present study, males constituting 84.61% of the young adults as with few other studies of stroke where males were more compared to females in both young and old age group.however in one retrospective study of stroke in young adults a slight female preponderance (52.4%) was noted. 20 In our study ischemic stroke was found to be more common in young adults when compared with elderly. However similar study in southern part of country shows more hemorrhagic lesions in young adults 21. Leading risk factors of young stroke were diabetes mellitus (53%), smoking (30.76%), hypertension on admission (30.76%), and valvular heart diseases (7.69%). A study on the characteristics of young stroke came up with the leading risk factors as smoking (56%) and hypertension (45%) 21 while in our study diabetes was leading cause which may be a factor to produce more of ischemic stroke than hemorrhagic. In this study, cardiac risk factors were identified in 7.69% of cases. The prevalence was found less than previous studies in our country where prevalence of rheumatic heart disease in the population contributes for significant patients of young stroke. This may suggest upcoming changes in lifestyle in developing country and chronic non communicable diseases are replacing classical communicable diseases. Mortality was higher in older patients (20.27%) compared to young (7.69%) in our study as older patients would have multiple co morbidities. CONCLUSION The study was meant for analyzing the prevalence, pattern, and risk factors of young stroke patients admitted in the medical wards of Medical College, PDU medical college. Among all patients 26% of the total stroke occurs in young adults <50 years. The proportion of ischemic stroke in young adults is higher than that of the same in elderly. Diabetes was identified as the most common risk factor of stroke in the young. Compared to stroke in elderly, valvular heart diseases, hypertension, smoking, cardiomegaly on x-ray, ECG changes (AF, RVH, LVH, VPC etc.) which are known risk factors, are higher in patients with young stroke. DM was common in both groups. The higher prevalence of diabetes in young stroke patients, pointing towards the changing pattern in population and same time emphasises the importance of 23 Int J Res Med. 2017; 6(2); e ISSN: p ISSN:

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