Stroke subtypes in Sri Lanka

Abstract

AIM: Data on stroke subtypes in Sri Lanka are limited. This is due to the unavailability of brain imaging facilities in most government hospitals in the country. In two leading private hospitals in Colombo, a high proportion of stroke patients are subjected to computerised tomography (CT) scanning. Therefore it was decide to study the stroke patients admitted to these two hospitals to determine the stroke subtypes METHODS: A prospective study of 103 consecutive first -ever stroke patients who were under the eare of the first author during the period 15lhMay 1995 lo30th August 1996 were studied. Diagnosis of stroke was made according to the WI10 definition. Transient ischaemic attacks (TIA) were not included in the study. The pathological subtype was confirmed by CT scan in 99 patients RESULTS: The age of the patients ranged from 37 to 94 years (mean 65y). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74%, intracerebral haemorrhage (ICH) 19% and subarachnoid haemorrhage (SAII) 6%. Of the 74 infarcts 31 (23%) were cortical, 30 (22%) were lacunar, 12(9%) were cerebellar and brains tern and 1 (0.7%) was a border zone infarct, In-hospilal mortality was 19% for all strokes: 14% for infarcts and 35% for haemorrhages. Mortality was lowest in (he lacunar stroke group (3%). In the cortical infarct group the mortality was 16%, in the ICH group 22% and in the SAM group 50%. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not possible due to differences in methodology. In developed countries in the West cerebral infarcs account for about 80% of alI first-ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East like Japan and Hongkong have reported higher proportion of haemorrhages; 27% of first-ever strokes in Hong Kong. In Sri Lanka The proportion of stroke subtypes seem to be intermediate between these countries from die west and east. Lacunar .stroke .seem to be commoner in Sri Lanka than in other countries. These differences may be because of differences in risk factors prevalent in our country.