Epidemiology of stroke subtypes and aetiology among Sri Lankan stroke patients

Abstract

BACKGROUND AND AIMS: Prevalence of stroke is on the rise in south Asia and the epidemiology is different to western countries. However, prevalence of stroke subtypes and aetiology is not reported of Sri Lanka. Therefore, we aimed to describe the same of Sri Lanka. METHODS: We analyzed all the acute stroke admissions to a stroke unit of a tertiary care hospital in Sri Lanka over 5 year from October 2013 to 2018. Data were collected prospectively using an interviewer administered questionnaire by interviewing patients and perusing medical records. Ischaemic strokes were classified on OCSP (Oxfordshire Community Stroke Project) and TOAST(Trial of Org 10172 in Acute Stroke Treatment) classifications RESULTS: 891 patients were admitted to stroke unit over 5 years; 765(85.5%) ischaemic strokes, 129 (14.5%) intracerebral haemorrhages (ICH), and 0(0%) sub-arachnoid haemorrhages (SAH). Of the ischemic strokes 16(1.8%) were total anterior circulation, 253(29.0%) partial anterior circulation, 543(62.3%) lacunar, 59(6.8%) posterior circulation infarcts on OCSP classification. 542 of ischaemic stroke patients who had complete investigations for TOAST classification were studied for aetiology of stroke. Atrial fibrillation was reported in only 14(2.7%) and more than 50% carotid stenosis was seen in 22(4.1%) ischaemic stroke patients. 17(3.1%) were of large artery atherosclerosis, 369(68.1%) small vessel occlusion, 11(2.0%) cardioembolic and 145(26.8%) undermined aetiology. CONCLUSIONS: Prevalence of ischaemic strokes, ICH and SAH were not different to western statistics in this Sri Lankan cohort of stroke patients. However, cardio-embolic and large artery strokes were less common compared to west and lacunar strokes were the commonest of ischemic strokes.