Death from stroke
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Death from Stroke: A Comprehensive Overview
Introduction to Stroke Mortality
Stroke is a leading cause of death globally, ranking as the second most common cause of mortality and a significant contributor to disability . The burden of stroke is particularly pronounced in low- and middle-income countries, where the majority of stroke-related deaths and disability-adjusted life years (DALYs) occur .
Sudden Death from Stroke
Sudden death, defined as death occurring within 24 hours of symptom onset, is a critical concern in stroke cases. Strokes account for 10-20% of all sudden deaths, with primary intracerebral hemorrhage and subarachnoid hemorrhage being the most common causes. In a study of residents in Rochester, Minnesota, 52 out of 255 stroke-related deaths were sudden, with hypertension being a significant risk factor in these cases.
Global Stroke Burden
The global burden of stroke has increased substantially over the past few decades. From 1990 to 2019, there was a 43% increase in deaths from stroke and a 143% increase in DALYs. This rise is attributed to demographic changes, particularly in developing countries where stroke incidence has more than doubled. The economic impact is also significant, with the global cost of stroke estimated at over $721 billion.
Mortality and Recurrence Post-Stroke
The prognosis after a first stroke varies by stroke type. In a large cohort study in China, the 28-day mortality rate was highest for intracerebral hemorrhage (47%) compared to ischemic stroke (3%) and subarachnoid hemorrhage (19%). Long-term mortality remains high, with a 5-year mortality rate of 17% for ischemic stroke and 28% for intracerebral hemorrhage. Recurrent strokes are also common, with 41% of survivors experiencing another stroke within five years.
Causes of Death in Severe Stroke Patients
In severe stroke cases, the leading causes of death are central nervous system-related issues such as brain herniation and central respiratory and circulatory failure, followed by multisystemic causes. Independent risk factors for mortality include brain herniation, multiple organ failure, dyslipidemia, and infections like community-acquired lung infection and hospital-acquired pneumonia.
Early Mortality Patterns
Early mortality after stroke shows a bimodal distribution, with peaks in the first week and the second to third weeks post-stroke. The majority of early deaths are due to transtentorial herniation, particularly in hemorrhagic strokes, while later deaths are often due to complications from immobility, such as pneumonia and sepsis.
Stroke in Young Individuals
Although less common, stroke can also cause sudden death in young individuals. A study in Denmark found that hemorrhagic strokes, particularly subarachnoid hemorrhages, were the primary cause of sudden death in individuals aged 1-49 years. Increased awareness and early detection of stroke symptoms in young people could potentially reduce these sudden deaths.
Conclusion
Stroke remains a major global health challenge with significant mortality and morbidity. Sudden death from stroke is a critical issue, particularly in cases of hemorrhagic stroke. The global burden of stroke continues to rise, especially in low- and middle-income countries. Understanding the patterns and causes of stroke-related deaths can inform better prevention and management strategies to reduce the impact of this devastating condition.
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