Risk factors of stroke

Non modifiable:

  • Age – the risk of stroke is double every 10 years after 55 years old.
  • Sex – Generally, men have higher prevalence of stroke than women except in between 35-44 year-olds and over 85 year-olds when women have slightly greater age specific incidence than men.
  • Ethnicity/race
  • Family history of stroke – Both paternal and maternal stroke history will contribute to high risk. The risks also associated with genetic and environmental factors.

Modifiable:

  • High blood pressure (both systolic and diastolic)
  • Cigarrette smoking – Both active and passive smokers are considered major risk factors for stroke. For those who stop smoker for 5 years or longer, the risk are cthe same with non smokers.
  • Diabetes mellitus
  • Atrial fibrillation
  • Coronary heart disease
  • Hyperlipidemia
  • Obesity
  • Physical inactivity
  • Raised homocysteine levels
  • High dietary salt intake
  • Heavy alcohol consumption
  • Previous stroke
  • Transient ischemic attack
  • Oral contraceptive pills
  • Pregnancy

Related:

 

Reference:

  1. Clinical Practice Guidelines. Management of Ischaemic Stroke. June 2006. Ministry of Health Malaysia.

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Differential diagnosis of stroke

Stroke is a clinical syndrome. It is characterized by rapidly developing clinical symptoms and/or signs of focal/global and loss of cerebral function. The symptoms lasting more than 24 hours and may lead to death. Stroke syndrome has no apparent cause other than vascular origin.

Transient ischaemic attack is another clinical syndrome almost similar like stroke syndromes. It is characterized by an acute loss of focal cerebral or monocular function.  The symptoms are lasting less than 24 hours. It has been thought the symptoms occur due to the inadequate blood supply to cerebral or ocular as a result of arterial thrombosis or embolism.

Differential diagnosis of stroke syndromes:

TIA/stroke Hemorrhage
  • Middle cerebral artery stroke
  • Anterior cerebral artery stroke
  • Posterior cerebral artery stroke
  • Watershed stroke
  • Thalamic lacune
  • Vertebrobasilar ischemia
  • Pontine lacune
  • Midbrain stroke
  • Pure motor hemiplegia
  • Ataxic hemiparesis
  • Lateral medullary stroke
  • Temporal lobe stroke
  • Subarachnoid hemorrhage
  • Cerebellar hemorrhage
  • Thalamic hemorrhage
  • Pontine hemorrhage
  • Putaminal hemorrhage

 

Other differential diagnosis of “stroke” – the following problems may present like stroke. It should always be considered in unconscious patients or patients presented with muscle weakness or other neurological deficits.

  • Metabolic/toxic encephalopathy (hypoglycemia, non ketotic hyperglycemia, Wernicke-Korsakoff syndrome, drug intoxication)
  • Epileptic seizures (postictal Todd’s paresis)
  • Hemiplegic migraine
  • Structural intracranial lesions (e.g.: subdural hematoma, brain tumor, arteriovenous malformation)
  • Encephalitis (e.g.: herpes simplex virus), brain abscess, tuberculoma
  • Head injury
  • Hypertensive encephalopathy
  • Relapsing multiple sclerosis
  • Conversion disorders
  • Hyperviscosity syndrome
  • Peripheral nerve lesion (e.g.: Guillaine Barre syndrome)

Related:

 

Reference:

  1. Clinical Practice Guidelines. Management of Ischaemic Stroke. June 2006. Ministry of Health Malaysia.
  2. David S. Smith et al. Field Guide to Bedside diagnosis. 2nd edition. 2007. Lippincott Williams and Wilkins.
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