Clinical Profile of Patients with Brainstem Stroke Admitted to KLES Dr Prabhakar Kore Hospital and Medical Research Centre – A Cross Sectional Study

Abstract

Background and objectives ABSTRACT Globally there are approximately 5.8 million people who die from stroke each year and two-third of all stroke occur in people living in developing countries and there are globally 16.3 million new stroke events each year. The present study was undertaken to know various clinical presentation and correlation with anatomical site with neuroimaging. Methodology This one year cross-sectional study was conducted at KLES Dr Prabhakar Kore Hospital and Medical Research Centre Belgaum, during the period of January 2009 to December 2009 on 33 adult patients with brainstem stroke. Detailed history, clinical examination, blood investigations and cranial imaging were performed. Results Majority ( 36.3% ) of patients were in the age group of 45 to 54 years with male predominance ( 63.50% ) and presented with limb weakness ( 81.8% ) . On admission, 39.4% patients had GCS score < 8. The commonest cranial nerve palsy observed was combined 3 rd , 4 th and 6 th nerve palsy ( 36.3% ) . The ischemic brainstem stroke was more common ( 87.5% ) than hemorrhagic stroke ( 12.2% ) . On neuroimaging, in patients with ischemic stroke commonest lesion was pontine infarct ( 39.4% ) and midbrain and pontine bleed ( 9.3% ) in hemorrhagic stroke. The most common associated risk factor was hypertension ( 60% ) . Mortality was high in patients of GCS score ≤ 8 ( 61.5% ) . Patients with hemorrhagic brainstem IV stroke had higher mortality ( 75% ) compared to ischemic brainstem stroke ( 17.2% ) . Interpretation and conclusion Nearly half of patients presented with classical well defined brainstem syndrome which was further confirmed on neuroimaging and it was pointing towards the involvement of the brainstem. Among known risk factors, hypertension was the commonest risk factors in both ischemic and hemorrhagic brainstem stroke. The mortality was higher in hemorrhagic stroke compared to ischemic brainstem stroke.