Ischaemic Vs Hemorrhagic Stroke

Ischaemic vs Hemorrhagic Stroke: A Comparative Analysis

Global Burden and Trends

Incidence and Mortality Rates

The global burden of both ischaemic and hemorrhagic strokes has increased significantly from 1990 to 2010. The incidence of ischaemic stroke rose by 37%, while hemorrhagic stroke saw a 47% increase. Mortality rates also climbed by 21% for ischaemic strokes and 20% for hemorrhagic strokes during this period. However, high-income countries experienced a reduction in the incidence and mortality rates for both types of strokes, whereas low-income and middle-income countries saw an increase in the incidence of hemorrhagic strokes by 22% and a non-significant increase in ischaemic strokes by 6%.

Disability-Adjusted Life Years (DALYs)

The number of DALYs lost due to ischaemic and hemorrhagic strokes also increased globally, with an 18% rise for ischaemic strokes and a 14% rise for hemorrhagic strokes. High-income countries saw a significant reduction in DALYs lost for both stroke types, while low-income and middle-income countries experienced a reduction in DALYs lost for hemorrhagic strokes but not for ischaemic strokes.

Risk Factors and Predictors

Common Risk Factors

Both ischaemic and hemorrhagic strokes share several common risk factors, including hypertension, age, and smoking. These shared risk factors suggest a common pathogenesis involving arterial wall damage, inflammation, and molecular changes. Additionally, cancer patients are at an increased risk for both types of strokes, particularly within the first six months following a cancer diagnosis.

Specific Predictors for Hemorrhagic Transformation

In the context of acute ischaemic stroke, hemorrhagic transformation (HT) is a significant concern, especially following reperfusion therapies like intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Common predictors for HT include atrial fibrillation, high NIHSS scores, and hyperdense artery signs. Age and serum glucose levels are also significant predictors for symptomatic intracerebral hemorrhage (sICH).

Clinical and Radiological Differences

Stroke Characteristics

In a study conducted in Sri Lanka, it was found that patients with hemorrhagic strokes presented to hospitals earlier and exhibited more severe symptoms such as altered consciousness, dysphasia, and gaze palsy compared to those with ischaemic strokes. Hemorrhagic stroke patients also had higher NIHSS scores and more severe initial disability.

Diagnostic Tools

Non-contrast CT scans are commonly used to differentiate between ischaemic and hemorrhagic strokes. Advanced imaging techniques like CT perfusion imaging and angiography can further identify large vessel occlusions, aiding in the diagnosis and treatment of ischaemic strokes.

Prognosis and Outcomes

Functional Outcomes and Mortality

Hemorrhagic strokes generally result in more severe functional disability and higher mortality rates compared to ischaemic strokes. Patients with hemorrhagic strokes are also at a higher risk for subsequent cardiovascular-related mortality and all-cause mortality. However, the risk of subsequent cardiovascular events is similar between the two stroke types, indicating that both groups should be considered high-risk populations for future cardiovascular events.

Long-term Morbidity

Hemorrhagic transformation in patients with acute ischaemic stroke, especially those requiring anticoagulation, leads to significant long-term morbidity and mortality. Identifying factors associated with hemorrhagic transformation is crucial for improving patient outcomes.

Conclusion

Both ischaemic and hemorrhagic strokes present significant global health challenges, with increasing incidence and mortality rates, particularly in low-income and middle-income countries. While they share common risk factors, the clinical presentation, severity, and outcomes can differ markedly. Advanced diagnostic tools and targeted treatment strategies are essential for improving prognosis and reducing the global burden of these debilitating conditions. Further research is needed to better understand the specific risk factors and mechanisms underlying each stroke type to develop more effective prevention and treatment strategies.

Summary

Not a yes or no question