DISTRIBUTION OF STROKE BY AGE GROUPS – EXPERIENCES OF A STROKE CENTER IN ISTANBUL

Yıl 2024, , 135 - 142, 29.04.2024

Işıl Kalyoncu Aslan , Leyla Ramazanoglu , Irmak Salt , Pelin Doğan Ak

https://doi.org/10.18229/kocatepetip.1159106

Öz

OBJECTIVE: Stroke is a disease that can occur at any age. Advanced age is an irreversible risk factor for both hemorrhagic stroke and ischemic stroke, and the increased risk becomes evident with advancing decades. This study was aimed to reveal the differences between the age groups of acute stroke patients according to gender, stroke etiology, acute ischemia treatments, ischemia localization, and causes.
MATERIAL AND METHODS: A retrospective evaluation of 3665 consecutive inpatients with a diagnosis of cerebrovascular event between September 2017 and September 2020 was performed, including data on age, gender, stroke type, treatment of acute ischemic stroke, and etiologic classification.
RESULTS: Of the patients, 3299 patients (90%) were diagnosed with a transient ischemic attack (TIA)/ischemic stroke, 302 (8.24%) with hematoma, 51 (1.39%) with subarachnoid hemorrhage (SAH), 13 (0,35%) with cerebral venous thrombosis (CVT). The incidence of stroke in women increased over the age of 65 years. The intracerebral hematoma was most common in the age range of 65-84 years, 55.3% of them were male. SAH was most common in the 45-54 age group, 62.7% were women, all SVT patients were under the age of 75, and 31.2% were women. Diagnosis of TIA/ischemic stroke was most common in the 75-84 age group, 54.4% were male. Acute ischemic stroke treatments were mostly applied to the stroke group younger than 45 years of age (31.2%) and at least to the group over 95 years of age (19.4%). Anterior system involvement was present in 67.4% of the patients. Involvement of the anterior and posterior systems (5.5%) was most common over the age of 95. Despite etiological investigations, the cause of stroke could not be determined in 1385 (41.9%) patients. Cardioembolic strokes increased linearly with age.
CONCLUSIONS: This study shows the distribution of stroke center patients by age groups. It is noteworthy that the risk of stroke increases with age in women and the rate of ischemic stroke, the cause of which cannot be determined, despite advanced etiological studies.

Anahtar Kelimeler

Stroke, Age groups, Demographics

İNMENİN YAŞ GRUPLARINA GÖRE DAĞILIMI - İSTANBUL'DA BİR İNME MERKEZİNİN DENEYİMLERİ

Öz

AMAÇ: İnme her yaşta görülebilen bir hastalıktır. İleri yaş hem hemorajik inme hem de iskemik inme için değiştirilemez risk faktörüdür ve ilerleyen on yıllarla birlikte risk artışı belirginleşir. Bu çalışmada akut inme hastalarının yaş gruplarına göre cinsiyet, inme etiyolojisi, uygulanan akut iskemi tedavileri, iskemi lokalizasyonu ve nedenleri arasındaki farklılıkların ortaya konulması amaçlandı.
GEREÇ VE YÖNTEM: Eylül 2017 - Eylül 2020 arasında serebrovasküler olay tanısı ile yatarak tedavi gören ardışık 3665 hastanın yaş, cinsiyet, inme tipi, akut iskemik inme tedavisi ve etiyolojik sınıflamasına ait bilgileri retrospektif olarak değerlendirildi.
BULGULAR: Hastaların 302’si hematom (%8,24), 51’i (%1,39) subaraknoid kanama (SAK), 13’ü (%0,35) serebral venöz tromboz (SVT), 3299’u (%90) geçici iskemik atak (GİA)/iskemik inme tanısı aldı. Kadınlarda inme sıklığı 65 yaş üzerinde artmaktaydı. İntraserebral hematom en sık 65-84 yaş aralığındaydı, %55,3’ü erkekti. SAK en sık 45-54 yaş grubunda saptandı, %62,7’si kadındı, SVT hastalarının hepsi 75 yaş altındaydı, %31,2’si kadındı. GİA/iskemik inme tanısı en sık 75-84 yaş grubundaydı, %54,4’ü erkekti. Akut iskemik inme tedavileri en çok 45 yaş altı inme grubuna (%31,2), en az 95 yaş üzerindeki gruba (%19,4) uygulanmıştı. Hastaların %67,4’ünde ön sistem tutulumu vardı. Ön ve arka sistem birlikte tutulumu (%5,5) en çok 95 yaş üzerinde görüldü. Etiyolojik araştırmalara rağmen 1385 (%41,9) hastada inme nedeni belirlenemedi. Kardiyoembolik inmeler yaş ile birlikte lineer olarak artış gösterdi.
SONUÇ: Bu çalışma; inme merkezi hastalarının yaş gruplarına göre dağılımını göstermektedir. Kadınlarda yaş ile inme riskinin artması ve ileri etiyolojik araştırmalara rağmen nedeni belirlenemeyen iskemik inme oranı yüksekliği dikkat çekmektedir.

Anahtar Kelimeler

İnme, Yaş grupları, Demografi

Kaynakça

• 1. Whisnant JP, Basford JR, Bernstein EF, Cooper ES, Dyken ML, Easton JD, et al. Special report from the National Institute of Neurological Disorders and Stroke. Classification of Cerebrovascular Diseases III. Stroke.1990;21:637-76.
• 2. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41(2):105-14.
• 3. Mendelson SJ, Prabhakaran S. Diagnosis and management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review. JAMA 2021;325(11):1088-98.
• 4. GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-80.
• 5. Ekker MS, Verhoeven JI, Vaartjes I, Jolink WMT, Klijn CJM, de Leeuw FE. Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality. JAMA. 2019(4);321(21):2113-23.
• 6. Demirci S, Yalçıner BZ, Bakaç G, Dayan C, Aysal F. İnmelerde tekrarlayıcılığı etkileyen risk faktörleri. Düşünen Adam Psikiyatri ve Nöroloji Bilimleri Dergisi. 2010;23:38-43.
• 7. Kıyan S, Özsaraç M, Ersel M, ve ark. Acil servise başvuran akut iskemik inmeli 124 hastanın geriye yönelik bir yıllık incelemesi. Akademik Acil Tıp Dergisi. 2009;8(3):15-20.
• 8. Soyuer F, Ünalan D, Öztürk A. Serebral infarkt ve kanama’da sosyodemografik ve klinik profil. Türk Serebrovasküler Hastalıklar Dergisi. 2007;13(1):3-7.
• 9. Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke. 1994;25(4):808-13.
• 10. Öztürk B, Özön AÖ. İskemik inme ve cinsiyet. Akd Tıp Dergisi. 2020; 6(1):59-65.
• 11. Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020;141(9):139-596.
• 12. Casaubon LK, Boulanger JM, Blacquiere D, Boucher S, Brown K, Goddard T, et al. Heart and Stroke Foundation of Canada Canadian Stroke Best Practices Advisory Committee. Canadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015. Int J Stroke. 2015;10(6):924-40.
• 13. Broderick J, Brott T, Kothari R, et al. The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks. Stroke. 1998;29(2):415-21.
• 14. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43-53.
• 15. Chen RL, Balami JS, Esiri MM, Chen LK, Buchan AM. Ischemic stroke in the elderly: an overview of evidence. Nat Rev Neurol. 2010;6(5):256-65.
• 16. Fonarow GC, Reeves MJ, Zhao X, Olson DM, Smith EE, Saver JL, et al. Get With the Guidelines-Stroke Steering Committee and Investigators. Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation. 2010(23);121(7):879-91.
• 17. Russo T, Felzani G, Marini C. Stroke in the very old: a systematic review of studies on incidence, outcome, and resource use. J Aging Res. 2011;2011:108785.
• 18. Kumral E, Ozkaya B, Sagduyu A, et al. The Ege Stroke Registry: a hospital-based study in the Aegean region, Izmir, Turkey. Analysis of 2,000 stroke patients. Cerebrovasc Dis. 1998;8(5):278-88.
• 19. Sevin Balkan (Editör). Serebrovasküler Hastalıklar. In: Kumral E, Balkır K. İnme epidemiyolojisi. 1inci Baskı, Ankara: Güneş Kitabevi; 2002:38–47.
• 20. Demir C, Berilgen MS, Bulut S, Ülger M.A, Özel S. Yukarı Fırat Bölümünde Genç İskemik İnme Olguları. Turkiye Klinikleri J Med Sci. 2007;27:791-96.
• 21. Rexode KM. Emerging risk factors in women. Stroke 2010; 41:9-11.
• 22. Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(2):517-84.
• 23. Sacco RL, Boden-Albala B, Gan R, Chen X, Kargman DE, Shea S, et al. Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol. 1998;147(3):259-68.
• 24. Hayat tabloları 2017–2019. https://data.tuik.gov. tr Erişim Tarihi: 17.09.2020.
• 25. Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8): 254-743.
• 26. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. Lancet Neurol 2009; 8 (4): 355-69.
• 27. de Rooij NK, Linn FH, van der Plas JA, et al. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry. 2007;78(12):1365- 72.
• 28. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791-98.
• 29. Kaya D. The diagnosis and treatment of cerebral venous thrombosis. Türk Nöroloji Dergisi. 2017;23:94-104.
• 30. Demirci Şahin A, Üstü Y, Işık D. Serebrovasküler hastalık geçiren hastaların demografik özellikleri ve birinci basamak sağlık merkezlerinde önlenebilir risk faktörlerinin değerlendirilmesi. Ankara Med J. 2015;15(4):196-208.
• 31. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.
• 32. Topçuoğlu MA, Arsava EM, Özdemir AÖ, Gürkaş E, Örken DN, Öztürk Ş. Akut inme tedavisinde intravenöz trombolitik tedavi: sık görülen sistemik sorunlar ve çözümleri. Turk J Neurol. 2018;24:13-25.
• 33. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10(11):1002-14.
• 34. Chatzikonstantinou A, Wolf ME, Hennerici MG. Ischemic stroke in young adults: classification and risk factors. J Neurol. 2012;259(4):653-9.
• 35. Fisher M (Edited by). Handbook of Clinical Neurology. Stroke Part II: Clinical Manifestations and Pathogenesis. In: Piechowski-J´o˙zwiak B, Bogousslavski J. Posterior circulation strokes. 1st ed. Elsevier. 2008:537-58.
• 36. İnan RA, Özer D, Barut BÖ. Üçüncü basamak sağlık merkezinde genç iskemik inme hastalarında etiyolojik inceleme. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi. 2021;16(1):46-52.
• 37. Arboix A. Increasing relevance of acute cerebrovascular disease in very old patients. Eur J Neurol. 2007;14(8):833-4.
• 38. Rojas JI, Zurrú MC, Romano M, Patrucco L, Cristiano E. Acute ischemic stroke and transient ischemic attack in the very old--risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years. Eur J Neurol. 2007;14(8):895-9.
• 39. Kamel H, Healey JS. Cardioembolic Stroke. Circ Res. 2017;120: 514–26.
• 40. Varona JF, Guerra JM, Bermejo F, Molina JA, Gomez de la Cámara A. Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol. 2007;57(4):212-8.
• 41. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015;11(24):157-64.
• 42. Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009;40(4):1195-203.
• 43. Kes VB, Zavareo I, Demarini V. Etiology, and diagnostic workup in young stroke patients. Period Biol. 2012;114(3):355–9.
• 44. Ji R, Schwamm LH, Pervez MA, Singhal AB. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol. 2013;70(1):51-7.
• 45. Larrue V, Berhoune N, Massabuau P, et al. Nasr N. Etiologic investigation of ischemic stroke in young adults. Neurology. 2011(7);76(23):1983-8.
• 46. Uzar E, Çevik M U, Yücel Y ve ark. İskemik İnmeli Genç Hastaların Demografik, Etyolojik ve Risk Faktörleri. Düzce Medical Journal. 2012;14(3): 32-36.