Urban Versus Rural Egypt: Stroke Risk Factors and Clinical Profile: Cross-Sectional Observational Study

Do stroke services still show sex differences? A multicenter study

BACKGROUND

The issue of sex differences in stroke has gained concern in the past few years. However, multicenter studies are still required in this field. This study explores sex variation in a large number of patients and compares stroke characteristics among women in different age groups and across different countries.

METHODS

This multicenter retrospective cross-sectional study aimed to compare sexes regarding risk factors, stroke severity, quality of services, and stroke outcome. Moreover, conventional risk factors in women according to age groups and among different countries were studied.

RESULTS

Eighteen thousand six hundred fifty-nine patients from 9 countries spanning 4 continents were studied. The number of women was significantly lower than men, with older age, more prevalence of AF, hypertension, and dyslipidemia. Ischemic stroke was more severe in women, with worse outcomes among women (p: < 0.0001), although the time to treatment was shorter. Bridging that was more frequent in women (p:0.002). Analyzing only women: ischemic stroke was more frequent among the older, while hemorrhage and TIA prevailed in the younger and stroke of undetermined etiology. Comparison between countries showed differences in age, risk factors, type of stroke, and management.

CONCLUSION

We observed sex differences in risk factors, stroke severity, and outcome in our population. However, access to revascularization was in favor of women.

Gender disparity versus equality in acute stroke: a Middle Eastern country hospital-based study

Background

Acute stroke management is well-established in developed countries with no gender difference. Yet, in developing countries there are reports on gender disparity in medical services including stroke services. Egypt, a developing low-middle-income country, heavily populated, in the Middle East is a good example to answer whether acute ischemic stroke service is provided equally to males and females or there is disparity in risk factors, onset to door (OTD), door to needle (DTN), and outcome. The current study was prospective observational analytical hospital-based study, on acute ischemic stroke cases admitted to Nasr city insurance hospital stroke unit between September 2020 and September 2022.

Results

350 cases were included, 257 males and 93 females. Hypertension was the commonest risk factor 66% males and 81% females P = 0.011, atrial fibrillation was predominant in females P < 0.001, smoking was predominant in males P < 0.001. Median OTD in hours was 8.0 among both genders with minimum zero and maximum 96 h in males compared to minimum 1 and maximum 120 h in females, DTN was around 30 min with no significant difference. Median NIHSS on which rtPA was administered was 12.5 (6-13) in females compared to 10 (6-12) in males. Males who did not receive rtPA had a better mRS on discharge and on 90 days P = 0.01, 0.009, respectively, while there was no significant difference on discharge and 90 days between both genders on receiving rtPA.

Conclusions

No gender disparity was found in DTN, discharge outcome, and 90 days among rtPA recipients. Females tended to have higher NIHSS and relatively delayed presentation to ER with less favorable outcome at discharge and 90 days in case of not receiving rtPA. Encouraging earlier arrival and conducting awareness campaigns for risk factors management is warranted.

The Clinical Characteristics of Patients with Pre-Existing Leukoaraiosis Compared to Those Without Leukoaraiosis in Acute Ischemic Stroke

BACKGROUND

Leukoaraiosis (LA) is a finding in the elderly, that might be asymptomatic or can impact their motor and cognitive functions. We studied the presence of LA in the MRI of patients with AIS and its impact on functional outcome at 3 months.

METHODS

500 consecutive patients diagnosed as AIS were enrolled. Medical history included pre-medication by antiplatelets or statins, and vascular risk factors were reported by history and laboratory investigations. Severity of stroke was assessed by NIHSS and stroke outcome was evaluated on discharge and at 3 months by modified Rankin scale (mRS). LA was diagnosed by MRI-FLAIR sequence and delineated from acute infarction by diffusion-weighted image. And accordingly, patients were divided into group A (absent LA) and group B (present LA).

RESULTS

460 patients completed the study, with 53% of patients on antiplatelet therapy and 11.7% on statins prior to stroke. The percentage of patients with LA was significantly more than those without LA. Patients with LA showed a significantly higher age, more frequent and longer duration of diabetes and hypertension, ischemic heart disease, previous stroke/TIA and antiplatelet intake. Microbleeds were more and mRS was worse in LA group.

CONCLUSION

The presence of LA in the background MRI of AIS patients is accompanied by the presence of more risk factors, and unfavorable outcome. Pre-medication with antiplatelets did not prevent the incidence of a new stroke especially in LA group. This might necessitate the identification of some medication for secondary prevention in patients with small vessel disease.

A review on SARS-CoV-2 and stroke pathogenesis and outcome

Severe acute respiratory syndrome corona virus 2 hit strongly and hardly the entire globe for more than 1 year with a morbidity exceeding 139 million and a mortality approaching 3 million worldwide since its emergence in China in December 2019 until April 2021.

Although being termed after its ancestor the acute respiratory syndrome corona virus that emerged in 2002. Yet, the current corona virus has its unique devastating presentations being pulmonary and extra pulmonary.

In the current review, a highlight on the role played by corona virus 2 on pathogenesis and outcome of stroke is presented with an attempt to point to the most approved ways through which the corona virus induce stroke being disturbance in renin angiotensin system and angiotensin-converting enzyme 2 receptors downregulation, endothelial cell damage with coagulopathy, cytokine storm, and platelet as well as outcome and risks in patients who are suffering stroke with modifiable vascular risk factors and catching the severe acute respiratory syndrome corona virus 2.