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GUEST EDITORIAL
Year : 2008  |  Volume : 11  |  Issue : 5  |  Page : 2-3
 

Stroke in India: A silent epidemic


Department of Neurology, Head of Research, Betty Cowan Research and Innovation Center, Christian Medical College, Ludhiana-141 008, Punjab, India

Correspondence Address:
Jeyaraj Durai Pandian
Department of Neurology, Head of Research, Betty Cowan Research and Innovation Center, Christian Medical College, Ludhiana-141 008, Punjab
India
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How to cite this article:
Pandian JD. Stroke in India: A silent epidemic. Ann Indian Acad Neurol 2008;11, Suppl S1:2-3

How to cite this URL:
Pandian JD. Stroke in India: A silent epidemic. Ann Indian Acad Neurol [serial online] 2008 [cited 2014 Nov 24];11, Suppl S1:2-3. Available from: http://www.annalsofian.org/text.asp?2008/11/5/2/41713


Recently in our stroke unit, a 40-year-old driver was admitted with right-sided weakness and Broca's aphasia. He had a total anterior circulation infarct. He was the only earning member of the family. He was bedbound at 1 month follow-up. I think this would be the scenario in a substantial proportion of stroke patients in India and other developing countries.

Stroke is the second leading cause of death and a major cause of disability worldwide. Two-thirds of stroke deaths worldwide occur in developing countries. [1],[2] According to recent reports from India, the incidence and 30-day case fatality rates are higher than that in the developed countries. [3],[4] In both rural and urban India, there has been an increase in the incidence of noncommunicable diseases such as stroke and coronary artery disease. [2]

Stroke treatment has shown rapid advances over the last decade or so. Proven therapies include management of acute stroke patients in a stroke unit, intravenous thrombolysis (rtPA), use of aspirin within 48 h and decompressive surgery for malignant middle cerebral artery infarction. Effective measures for secondary prevention are the use of antiplatelets, warfarin in atrial fibrillation, endarterectomy for carotid stenosis and cholesterol reduction. [1] Among the various strategies, rapid diagnosis, implemention of early preventive treatment, early recognition of complications and mobilization improve the overall outcome of these patients. Management of these patients in acute stroke care units has a major impact on communities than that of treatment with thrombolysis. [5] There have been rapid changes in acute treatment, interventions and neuroimaging techniques. It is an appropriate moment that the Annals of Indian Academy of Neurology is bringing out this supplement regarding the incidence of stroke.

It is impossible to report all major advances in the field of stroke medicine. Hence, we have focused on topics related to acute treatment of ischemic stroke, including early and long-term rehabilitation. The supplement is divided into four sections. In the first section, Dr. Sen and Professor Oppenheimer discuss the bedside assessment, differential diagnosis, stroke mimics and atypical presentations of stroke in an elaborate manner. In the era of rapid diagnosis by using neuroimaging techniques, bedside assessment is equally important in excluding stroke mimics.

The second section reports various aspects of stroke thrombolysis. Dr. Dhamija and Professor Donnan highlight various imaging techniques used for the evaluation of patients for thrombolysis. Dr. Sylaja and Dr. Demchuk address specific issues in the use of intravenous (IV) thrombolysis such as selection of ideal candidates, thrombolysis in the elderly, and problems related to thrombolysis in developing countries. Dr. Bershad and Dr. Suarez have compared IV and intra-arterial (IA) thrombolysis in the light of recent trials. They have also explained the IA protocol. The role of transcranial Doppler has been written by a team of experts from Singapore (Dr. Sharma and Dr. Venketasubramanian), Chandigarh (Dr. Khurana), Birmingham and USA (Professor Alexandrov and Dr. Tsivgoulis).

The third section describes some of the common stroke etiologies noted in developing countries. Dr. Leys and Dr. Cordonnier's paper gives us an update regarding cerebral venous thrombosis noted commonly in the Indian subcontinent. Dr. Carod-Artal has covered the topic on the infections and stroke on the central nervous system. Dr. Leary and Professor Caplan have provided an extensive update regarding cardioembolic stroke.

The fourth section describes various aspects of stroke rehabilitation, which is a neglected area in our country. Professor Bernhardt's paper focuses on bed rest and very early mobilization in stroke. The role of occupational therapy has been explained very well by Ms. Tennille Rowland. Dr. Dilworth's review highlights the importance of swallow and communication assessment with emphasis on treatment strategies.

I sincerely thank all the authors for their contribution to this stroke supplement. I also express my gratitude to the Editor for providing me with this opportunity to assemble this supplement. I acknowledge the support I received from the Stroke Unit of Royal Brisbane and Women's Hospital, Brisbane (Dr. Read and Ms. Tennille Rowland). This supplement was my farewell venture toward the end of my three and a half years of stay in Brisbane, Australia.

I earnestly hope that this supplement will be informative to the readers of the Annals of Indian Academy of Neurology.

 
   References Top

1.Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008;371:1612-23.   Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Pandian JD, Srikanth V, Read SJ, Thrift AG. Poverty and stroke in India: A time to act. Stroke 2007;38:3063-9.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Das K, Banerjee TK, Biswas A, Roy T, Raut DK, Mukherjee CS, et al. A prospective community-based study of stroke in Kolkata, India. Stroke 2007;38:906-10.  Back to cited text no. 3    
4.Dalal P, Bhattacharjee M, Vairala J, Bhat P. UN millennium development goals: can we halt the stroke epidemic in India? Ann Indian Acad Neurol 2007;10:130-6.   Back to cited text no. 4    
5.Brainin M, Teuschl Y, Kalra L. Acute treatment and long-term management of stoke in developing countries. Lancet Neurol 2007;6:553-61  Back to cited text no. 5  [PUBMED]  [FULLTEXT]



This article has been cited by
1 Stroke program for India
Mishra, N.K., Khadilkar, S.V.
Annals of Indian Academy of Neurology. 2010; 13(1): 28-32
[Pubmed]



 

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