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The Frequency and Location of Hemorrhage and Infarction in Stroke Patients Having Hypertension by Computed Tomography (CT) Scan

Author(s): Mosarraf Hossain, Rashimul Haque Rimon, Md. Anarul Islam, Md. Shawkat Jamil, Mohammad Arif Raihan, Afroza Choudhury, Mehjabin Rashid

Introduction: Stroke is defined by the WHO as "The rapidly developing clinical symptoms and signs of focal (at times global) disturbance of cerebral function with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin. Hypertension is a major risk factor for stroke and antihypertensive therapy provides general benefits to patients with a history of stroke or transient ischemic attacks.

Objective: To know the frequency and location of hemorrhage and infarction in stroke patients having hypertension by computed tomography (CT) scan.

Materials and Methods: This observational cross sectional study was done among stroke patients admitted in Neurology department of Uttara Adhunik Medical College Hospital (UAMCH) who have history of hypertension or taking antihypertensive drugs. Sampling was purposive and 100 samples were included in this study. All patients presenting to the emergency or neurology unit with clinical features of stroke was referred to the radiology department for CT scan of the brain. A detailed cardiovascular and neurological examination was done by the attending physician.

Results: In this study mean age was 60.24(±11.73) years, minimum age was 42 and highest age was 85 years. Maximum stroke were found between the ages 65 to 74 years. The mean age was 66.23(±11.8) years. My study shows 66% were male and 34% were female, and male female ratio was 1.94:1. This study shows female preponderance between 60-69 years age group but in subsequent decades there was male preponderance (p>0.05 that was not statistically significant. This present study shows that the study subjects were from both urban and rural areas with slight urban dominance (57%). The present study shows 58% were ischemic stroke and 42% were hemorrhagic stroke. In my study, haemorrhage was also more common in untreated hypertensives (59.09%), whereas ischemia in treated cases (71.42%). This study reveals that ischemic stroke were found predominantly in stage-1 (15 cases; 25.86%) & in stage-II (28 cases; 48.27%) hypertensives where hemorrhage stroke were found predominantly in stage-III (22 cases; 52.38%) (p<0.05) that was statistically significant. Of the 58 patients with infarction, the middle cerebral artery was involved in approx 74 % the posterior cerebral artery in approx 16%, the anterior circulation in 10 %. Thus most of the stroke was involved the middle cerebral arterial territory (approx 74%). The posterior fossa was involved in 10 cases (16%) out of which 6 had cerebellar infarct and 4 had pontine infarct. CT scan of brain revealed hemorrhage in the region of capsule-ganglionic region (19 cases; 45.23%), thalamus (10 cases; 23.80%), cerebral cortex (06 cases: 14.28%), pons (03 cases; 7.14%) cerebellum (02 cases; 4.76%) and sub arachnoid hemorrhage (02 cases: 4.76%) respectively.

Conclusion: Hypertension is a major risk factor of stroke. Infarction is more common form of stroke than hemorrhage. CT scan is important to differentiate between cerebral infarction and intracerebral hemorrhage because nowadays, proper management of the acute stroke syndrome is based on the correct diagnosis of the pathological type. Treatment of hypertension significantly reduces the risk of stroke and its adequate control is a cornerstone in stroke prevention. Therefore, stroke prevention should be a primary focus for all health care providers.

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