STROKE IN YOUNG

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STROKE IN YOUNG:

STROKE IN YOUNG Dr. A.Bhagavati Rao Department of Gen. Medicine Guide –Prof. Dr M.Parvatisam M.D Co-guide – Prof. Dr.S.V.Ramanamurty M.D

INTRODUCTION:

INTRODUCTION Third leading cause of death following cardiac and cancer related diseases. Surviving it means living with some amount of disability. Leading cause of disability 31 % need assistance for daily living. 20% need assistance for walking 16% need admission into long time facility. Direct ( treatment ) costs and indirect ( lost productivity ) costs of stroke alarming.

REVIEW OF LITERATURE:

REVIEW OF LITERATURE Western countries annual incidence 111-180 per 100,000 population,and 9- 28 per young population. Point prevalence 400-700 per 100,000 population,150-200 per 100,000 population. According to an Indian studies 2 yr prevalence and annual incidence rates are 84 and 13 per 100,000 population. Difference due to different population structure.

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Cerebrovascular diseases account for 0.9-4.5% of all admissions. In other way 9.2 – 30% of all neurological diseases. These figures are much less compared with those of USA. Figures closer or more if compared for only adult population

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Prevalence of stroke in Indian population was found to be 18.8%-32%. Causes being cardiac ,carotid artery thrombosis,lipid & coagulation abnormalities, arteritis , intracranial tuberculosis, oc pill use in females ,hypertension, diabetes, cigarette smoking amongst others. Whatever may be the cause it was found that stroke prevalence in Indian population is higher than other countries.

AIMS AND OBJECTIVES:

AIMS AND OBJECTIVES To study in detail the clinical presentation and outcome of cases of stroke in the age group of 15-40 yrs by taking detailed history and thorough clinical examination. To correlate the disease with radiological imaging studies (CT & MRI ),carotid doppler,2Decho, homocysteine levels, lipid profile, fundus examination & autoimmune profile to determine the aetiology wherever necessary. To follow the outcome in the cases

MATERIAL AND METHODS:

MATERIAL AND METHODS The study will include the patients presenting with stroke in between the ages of 15 - 40 yrs that are admitted into the dept. of medicine and neurology in Swatantra Multispeciality hospital,Rajahmundry during the period from October 2009 – November 2011. In all cases the provisional diagnosis will be made by taking the detailed history & clinical examination as per the profoma. Outcome will be assessed by using Bogousslavsky criteria. Depending upon the clinical scenario relevant investigation will be done.

STUDY PROFOMA:

STUDY PROFOMA Name: Age: Sex: Address: Occupation: Unit: IP NO: Date of Admission: Date of Discharge: Presenting Complaint : H/O Presenting Illness : Duration: Onset: Sudden/Insidious progression: Continuous/Intermittent Associated symptoms: Headache / Vomitings / Convulsions / Loss of Consciousness / Fever / Speech disturbances / evidence of previous or concurrent episodes of embolism to other parts of body

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Motor Symptoms: Weakness Incoordination Involuntary movements Sensory Symptoms: Cranial nerve symptoms: Sense of smell Vision: Acuity/Color/Field Drooping of eyelids Double vision Sensation over face Asymmetry of face Dribbling of saliva Stasis of food Vertigo Tinnitus Deafness Hoarseness Nasal twang Nasal regurgitation Difficulty in swallowing Sphincter disturbances : Bowel Bladder

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Predisposing Factors: H/O similar illness in the family Obesity Smoking DM HTN Peripheral vascular disease Ischemic heart disease Rheumatic heart disease Syphilis Recent child birth Oral contraceptive pills Hypercholesterolemia Abortions H/O Past Illness : CVA / TIA / Hypertension / Diabetes Mellitus / Heart disease / Syphilis / Tuberculosis / Claudication / Bleeding disorders / Sickle cell disease / SLE Personal History : Smoking / Alcoholism / Exposure to STDs / Drug abuse / Martial status / No. of children / Diet

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Family History : Stroke / HTN / DM / Ischemic heart disease / Hyperlipidemia Physical Examination : Stature Nutrition Clubbing Anemia Cyanosis Icterus Edema Xanthomas Petechiae Purpura Rash Scar on penis Oral Ulcers Lymphadenopathy Neurocutaneous markers Thyromegaly Vital Data : Pulse: Upper limbs Lower limbs Blood pressure: Upper limbs Lower limbs Respiration: Temperature: Bruit over neck pr cranium:

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Neurological Examination : Handedness Consciousness Higher intellectual functions Speech Cranial nerves : Olfactory Optic Oculomotor Trochlear Abducent Trigeminal Facial Vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal Motor system : Upper limb Lower limb Right Left Right Left Nutrition

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Tone Power Coordination Abnormal movements Reflexes: Superficial Corneal Conjunctival Palatopharyngeal Abdominal Cremasteric Plantar Deep tendon reflexes Jaw jerk

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Biceps Triceps Supinator Knee Ankle Primitive reflexes: Visceral reflexes: Sensory system Pain: Superficial Deep Temperature: Hot Cold Touch: Fine Crude Joint Position Vibration: Cortical sensation

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