The Evolving Pattern and Outcome of Stroke at Moderate Altitude

BACKGROUND: The people residing in hills of this Sub-Himalayan region traditionally have a distinct lifestyle involving high level of physical activity. However, increased urbanization in the last two decades has led to changes in lifestyle of people. The present study was an endeavor to document changes in the pattern of stroke in people residing at moderate altitude. AIM: This study was aimed to study the evolving trends in clinical profile, risk factors, and outcome at 3 months in hospitalized patients of stroke in a Tertiary Care Hospital situated at moderate altitude. SETTING AND DESIGN: This prospective, observational study was carried out in a Tertiary Care Hospital, situated at 2000 m mean sea level, from July 2014 to June 2015 in Sub-Himalayan region of India. METHODS: The clinical features and risk factors profile of 235 patients of stroke consecutively admitted in hospital were analyzed, and findings were expressed in percentage. The profile was compared with a study conducted at this institute 15 years back. The outcome of patients at 3 months in terms of modified Rankin Scale >3 (mRS) and Barthel Index <60 (BI) was also studied. RESULTS: The occurrence of stroke as a cause of hospitalization was decreasing. Ischemic stroke was noted in 74%, and 26% had hemorrhagic stroke (HS). There was male predominance (58%), but affliction of females with stroke increased from 34% to 42%. The altered sensorium (P = 0.00) and neurological weakness (P = 0.024) were significantly associated with poor outcome in stroke. The occurrence of hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among indoor patients of stroke in the last 15 years. Poor outcome of 203 patients at 3 months follow-up in terms of mRS >3 was 79 (IS-47, HS-32) but in term of BI, 63 (IS-32, HS-31) had poor outcome. Overall HS had poorer outcome. Age >70 years, female sex, altered sensorium, hypertension, and diabetes mellitus, were observed as poor prognostic factors, but the association was significant with advanced age, headache, and altered sensorium. CONCLUSION: The occurrence of stroke decreased among hospitalized patients. Hypertension, diabetes mellitus, and coronary artery disease increased but smoking decreased among patients of stroke.