Recognize About Stroke

Stroke is Acute neurological dysfunction caused by vascular disturbance, acute procces, rapidly, sign and symptom based focal area in cerebral. Other name of disease : Cerebrovascular disease CVD, PPDO/GPDO.

Stroke is a rapidly developing clinical sign of focal or global disturbance of cerebral function with symptoms lasting 24 hours or longer, or leading to death with no apparent cause other than vascular sign (WHO).

Prevalence stroke in Europe 200/100.000 population (25%  relaps), US 135/100.000 (infarc 112, ICB 14, SAB 10/100.000 population. 

Exponensial trend linked with the age, 80-90 years old (300/100.000)  compared with 30-40 years old (3/ 100.000); Man > Women; In Netherlands ICB > 65 years old, the same of sex ratio (<65, W>M).

Case Fatality rate 36%;  In developed countries, mortality number 3, circulation  system (1) and cancer (2). 

In US mortality is  20.000 /year (cause of death number 5). 

In  Europe 100/100.000 population. (63.9/Sweden and 128,7/100.000 Scotland; CFR 10-12%, 88%  (> 65 years old).

Clasification of stroke.

a. National Institute of Neurological Disorder and Stroke (NINDS) : based on phatological procces :

• Cerebral Infarction :
• Intra Cerebral bleeding;
• Subarachnoidal bleeding

b. Based by Clinical Manifestation :

• Transient Ischemic Attack (TIA)
• Stroke in Evolution (SIE) atau Progressing Stroke
• Reversible Ischaemic Neurological Deficit (RIND)
• Completed Stroke

c. Based on Pathologic Procces :

•  Cerebral Infarction;Stroke Non Haemorrhagic : Clinical (TIA, RIND, SIE dan CS) : Causal : trombotic and embolic 
•  Stroke Haemorrhagic : Subdural bleeding; Sub arachnoidal  bleeding and  Intracerebral bleeding).

Risk Factor of Stroke :

• Unchangeable : age, ethnic, sex, family history.
• Changeable : Hipertention, DM, TIA, AF, Post stroke, Abnormality of lipoprotein, fibrinogen, smoking, alcoholic, homocysteinemia, virus infection and bacterial, oral contraseption, obesity, inactivity, cholesterolemi , physical and mental stress.

Stroke Prevention :

a. Primary Prevention

• Life style : emotional reduction, salt consumpsion, fat and calory limit, exercise, no smoking and vitamin
• Environment ( lead pollution)
• Biology : biological risk factors (sex, history), aspirin effect
• Health service : health education and regular blood pressure exam.

b. Secondary Prevention

• Life style : management of stres, dietetic regulation, stop smoking
• Environment : family counseling
• Biological : compliment of treatment and side effect reduction
• Health service : health education and evaluation of secondary causes

c. Tertiary Prevention:

• Life style :  stres reduction, exercise and,  stop smoking
• Environment : maintenance of safety condion : wheel chair, family support
• Biology : compliment of treatment, physical and speach therapy
• Health service : emergency medical technic and assurance.