Risk Factors, Etiology, and Infarction Patterns in Cerebrovascular Accidents in India

Stroke – a severe cerebrovascular condition marked by sudden neurological impairments, is showing rising incidence rates in India, presenting major public health challenges. A new study investigated stroke risk factors and etiology using the Trial of Org 10172 in acute stroke treatment (TOAST) classification and assessed infarct regions in cerebrovascular accident (CVA) cases. 

This cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pune – from January 2023 to January 2024. The researchers enrolled 100 adult CVA patients diagnosed through clinical and radiological criteria. Individuals with head trauma were excluded. Diagnostic procedures comprised routine biochemical tests, computed tomography (CT), magnetic resonance imaging (MRI) with angiography or venography, and bilateral carotid Doppler ultrasound.

Among the participants, 84% were males, and 44% were over 60, with hypertension as the leading risk factor affecting 75%, primarily among males (62%). Smoking and alcohol use were recorded in 51% and 50% of patients, respectively. Other significant risk factors were dyslipidemia (39%), diabetes (33%), chronic kidney disease (11%), and ischemic heart disease (10%). The most predominant event was ischemic stroke (80%) – frequently affecting the frontal (41%), parietal (37%), occipital (27%), and temporal (26%) lobes. In the TOAST classification, the most common were undetermined etiology with multiple causes (32%), followed by large artery atherosclerosis (30%).

From the results, it was concluded that hypertension, alcohol use, smoking, and hyperhomocysteinemia are the key risk factors for stroke occurrence – with ischemic strokes being the most common—predominantly impacting the cerebral lobes. Targeted prevention strategies focusing on hypertension control, lifestyle adjustments, and addressing comorbidities could improve patient outcomes and reduce stroke incidence.

Source: Reddy RH, Diggikar P, Mundada M, et al. Cureus. 2024;16(9):e68433. Published 2024 Sep 2. doi:10.7759/cureus.68433