Risk Factors of Lacunar Ischemic Cerebral Strokes
Keywords:lacunar stroke, risk factors, prevention
Acute cerebral stroke is one of the main causes of disability and mortality in the world. Every year, about 16 millions of people experience the first stroke, and about 7 millions die of it. In Ukraine, 100–110 thousands of people annually have stroke, and about 40 thousands of people in Ukraine die. Stroke prevention strategy is based on the detection and correction of stroke risk factors.
There are five subtypes of ischemic stroke (atherothrombotic, cardioembolic, lacunar, hemodynamic, hemoreologic). Today, many issues related to the etiology, pathogenesis, features of the clinical course of lacunar stroke are not resolved. Analysis of the pathogenesis of lacunar stroke showed that the leading internal risk factors are hypertension, diabetes mellitus, age, hypecholesterolemia and cardiac pathology. However, external (or social) modifying risk factors are poorly explored, although they play a significant role in the autoregulation of cerebral circulation.
The aim of the research was to study the range and to assess the impact of social risk factors on the incidence of lacunar cerebral ischemic stroke. We examined 140 patients with ischemic stroke aged 42 to 84 years (average age — 65.2 ± 87 years), we have used clinical and instrumental methods, in particular neuroimaging (computed tomography, magnetic resonance imaging), Doppler ultrasound of the major arteries of the head, electrocardiography, laboratory confirmation of diabetes mellitus and detailed clinical and anamnestic survey. Evaluation of external risk factors was carried out using specialized scale of social risk of stroke.
A statistical processing of the material was done. The study found that the most important internal factors with high probability of lacunar stroke was hypertension (100 %) and atherosclerotic vascular disease (96.1 %), although the degree of stenosis of blood vessels was hemodynamically insignificant. Among social risk factors, the major predictors affecting the development of cerebral ischemia by a mechanism of lacunar stroke were excessive stress environment (100 %), excessive nocturnal activity (73.1 %), long-term work with monitors (76.9 %) and irregular meals (65.3 %). Obtained combination of external and internal risk factors of cerebral ischemia will allow clinicians to identify timely the patients who are at risk for lacunar stroke, and to develop appropriate individual strategy of prevention.
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