INTRODUCTION

Stroke is defined by the World Health Organization as a sudden-onset syndrome characterized by focal or global changes in brain function, secondary to a disorder of vascular origin with an evolution longer than 24 hours. In industrialized countries, stroke is the main cause of morbidity and is among the leading causes of death, although the African continent still lacks epidemiological information about the disease.

Actually, Africa bears the greatest burden of hypertension, the strongest and most common risk factor for stroke. In view of this,strokes are an increasingly public health issue. The incidence and prevalence of stroke at Africa was estimated in 316 e 981 casos por 100 000 habitantes, which is a high incidence, prevalence and consequently case fatality of stroke.¹

The stroke surveillance is useful to determine the present and projected burden of the disease and monitoring the impact of future interventions. The development of new strategies, the efficient planning and delivery of stroke services, the effective application of current stroke prevention strategies are results of the rigorous stroke epidemiology and clinical data.¹

The limitation of the epidemiological quality of this population prevents the making of statements about the impact of stroke and consequent interventions in Africa. So, the knowledge of epidemiology of stroke in African countries allows comparison of estimates across regions and nations without methodological bias.

This study aims to know and describe the clinical and the radiological profile of patients with stroke attended and treated at Sagrada Esperança Clinic in 2018. Thus, it will be possible to characterize clinical aspects, describe the risk factors, imaging exams and identify statistical data of the patients.

METHODS

RESULTS

Of a total of 312 cases listed with a diagnosis of stroke, 211 were excluded for having a history of the disease, 18 for divergent diagnosis in the process, 8 cases for lack of exams or reports from the servers. 75 cases were included. Of the 75 processes observed, it was found that the most frequent age group was 41-60 years old with 34 (45%), followed by 61-80 with 31 (41%), the average age was 58.8 and ±13 standard deviation. Males were the most frequent with 45 (60%), and females with 30 (40%). There was a predominance of black patients 67 (89%) (Table 1).

There was a predominance of ischemic stroke with 42 (56%), compared to hemorrhagic stroke 32 (44%). According to the location of the lesion, the middle cerebral artery was the most affected 43 (57.3%), followed by the posterior cerebral artery with 20 (26.7%). As for the length of stay, most 37 (49.3%) remained for 5-9 days and 18 (24%) were hospitalized for less than 4 days, the average length of stay was 9.4±7.3 days. Most patients had a favorable outcome for discharge, representing 71 (95%), and 4 (5%) progressed to death (Table 2).

The clinical picture of the patients was quite varied, and hemiparesis was the most evident deficit in both ischemic stroke 34 (18%) and hemorrhagic stroke 18 (9%), followed by lip deviation with 28 (14%) present in ischemic stroke and 9 (59%) present in hemorrhagic stroke (Table 3).

Among the different risk factors that patients with stroke presented, it was observed that hypertension was the most evident factor, present 48 (64%), followed by heart disease 17 (22.7%) and diabetes mellitus 16 (21 .3%).

About the relationship between the type of stroke and the site of the lesion, the middle cerebral artery was the most affected region in both ischemic stroke 24 (32%) and hemorrhagic stroke, both intraparenchymal 17 (53.1%) and subarachnoid 2 ( 2.7%), followed by the posterior cerebral artery 9 (12%) in ischemic stroke and 11 (34.4%) in hemorrhagic stroke (Table 4).

DISCUSSION

Our main finding is the clinical characteristics and imaging profile of patients with cerebrovascular disease treated at the CSE from January 1 to December 31, 2018.

We found the black race obtained 89% of superiority in patients seen at the clinic with a diagnosis of stroke in the period under study. One explanation is the demographic component of the region. This is consistent with previous data showing a higher incidence of stroke in the black race, especially the ischemic event.

In the sociodemographic data, there was a mean age of 58.8 with a standard deviation of ±13, which corroborates with some retrospective studies, such as Goulart et al em 2016² on the characterization of stroke focusing on oral communication disorders in patients at a regional hospital in Brazil, in which the reported mean age was 59.8 with a standard deviation of 13.9. Cantarellas & Pinto em 2016³ in the study on the clinical and sociodemographic profile of patients hospitalized with stroke at the São Francisco University Hospital in Brazil, they also found a mean age of 63.9 years with a standard deviation of ± 11.7. Our results also corroborate the study of Leite, Nunes, & Corrêa em 2009 ⁽⁴on the epidemiological profile of patients affected by stroke, registered in the Family Health Strategy in Diamantina, a Brazilian city, in which they identified a mean age of 67.8 and sd±13.6. These data suggest the fact that although stroke is not a pathology exclusive to old age⁵, there is an increased incidence of stroke cases from 55 years of age onwards, and most cases occur at 66 years of age⁶.

Male patients tend to have a increased incidence of stroke.⁷⁾ This aspect was also observed in our study, in which, of the 75 patients, 60% were male. This data corroborates what was found by⁸in the study on clinical characteristics and treatment measures in stroke patients admitted to the Nekemte referral hospital in Western Ethiopia in which males accounted for 57.7%. Cantarellas e Pinto em 2016³had an incidence of 61% in males, and in a study⁵on stroke in young people, which assessed the frequency and imaging alterations of affected patients, carried out at the Sagrada Esperança Clinic in Luanda, found results in which men represented 52.8%. A plausible explanation for this increased incidence in mens is the fact that men are more prone to cardiovascular risk factors, since women have a hormonal protection that protects them until menopause.⁶

Among the cardiovascular risk factors presented by the patients in this study, AHT was the most frequent, being present in 64% of patients, even before the occurrence of a stroke, followed by heart disease 22.7% and diabetes mellitus 21.3% . Our finding is in line with the current literature, in which⁹evaluated the clinical findings and the main complications of stroke, carried out in brazil, in which hypertension was also the most frequent risk factor among study participants with 74%, heart disease and diabetes mellitus were 15% and 25%, respectively. Fekadu, Adola, Mosisa, Shibiru, & Chelmeba⁸, in 2019 also found HTA as the main factor being present in 63.2% of patients. It appears HTA is the main risk factor associated with stroke, both ischemic and hemorrhagic, and diabetes mellitus has gained an influential role in this process as a result of the current lifestyle adopted by populations^6,7

Obesity (10.7%), smoking (5.3%), dyslipidemia (4%) and alcoholism (2.7%) were risk factors that do not present great representation in comparison with other studies⁹, in which smoking was present in 22% and dyslipidemia in 11% of those studied. The data found by³also diverge from ours, in which smoking was present in 33%, alcohol consumption in 22% and dyslipidemia in 11%. This difference in risk factors can be explained by the different eating habits between the populations studied, without forgetting the genetic and environmental component.⁵

There was a higher incidence of IS in relation to HCV, 56% and 44% respectively, data that corroborate with the current literature⁵in which AVCI represented 55.6% while AVCH 45.4%. Our results differ from those found by¹⁰in his study on the clinical and epidemiological profile of patients hospitalized for stroke, according to the area covered by the family health strategy, in the municipality of Cáceres, Mato Grosso in Brazil, in which stroke accounted for 80.1%. A study¹¹obtained the profile of patients hospitalized for CVA in a hospital in Vale do Taquari in Brazil, in which CVA represented 84.8% of the cases studied. One explanation is by the fact that, although in high-income countries there is a significant incidence of stroke in relation to HCV, in African countries, HCV varies in a proportion from 29% to 57%, justified by a higher burden of uncontrolled HTA in the continent, since AVCH is related to uncontrolled hypertensive pathology.¹²

EAmong the types of HCV, intraparenchymal was the most frequent, representing 40% of the 75 patients in the study. Stroke is currently the main cause of physical disability in Europe, being responsible for a great financial burden on families¹³. The most frequent deficit was hemiparesis, present in 27% of patients, followed by lip deviation, present in 19% of them, both in stroke and stroke. This is consistent with¹¹, on 2014 and Cantarellas & Pinto, em 2016³, in which hemiparesis was also the most identified deficit followed by facial paresis. 11% of our patients had dysarthria and 7% aphasia, data that contrasts with those found by a study³in which patients with aphasia corresponded to 39% of the sample A plausible explanation is the fact that the same study presents a large number of patients with a previous history of stroke, some of which already had previous deficits.

The arterial territory most affected by stroke was the ACM (57.3%) followed by the ACP territory (26.7%). This is consistent with previous data showingthe place with the highest incidence of stroke is the territory of the ACM, preferentially related to HTA and diabetes mellitus, risk factors that were shown to be very prevalent in this study.¹⁴

Of the 75 patients, 49.3% remained hospitalized for 5 to 9 days, with a mean hospital stay of 9.4 and ±7.3 SD. The average hospital stay was 11 days and SD ± 7.8⁹. In this study, 5.3% of patients died, diverging from a study³, in which deaths accounted for 11%. Our data also contrast with those found¹⁰, in which deaths corresponded to 33.3% and 24%, respectively, in the two communities studied. This contrast is justified by the difference in sample size of the different studies.

Our study has some limitations. First, there was the absence of some processes listed with the diagnosis of stroke, the absence of sociodemographic and clinical data, and absence of some exams and reports in the computer database and Synapse.

Although stroke cases in Africa have become increasingly frequent, data related to their mortality remains scarce, as stroke remains a neglected disease in several African countries¹². Further studies characterizing the distribution and clinical characteristics of patients with stroke in Africa may facilitate the implementation and evaluation of stroke control interventions on the continent.

In the present study, we had the following limitations: absence of some processes listed with the stroke diagnosis, lack of both sociodemographic and clinical data in some processes found in the files and the absence of some exams and reports in the computer database and Synapse.

CONCLUSION

The present study provided information on the clinical and imaging profile of stroke patients treated at the CSE, in which most of them were aged between 40-80 years old, he was male and black. The most of the patients had lesions in the territory of the middle cerebral artery, with deficits being more hemiparesis and facial paresis are common.