Stroke Case Fatality Research Articles

Seasonal Patterns of Incidence and Case Fatality of Stroke in Malmö, Sweden: The STROMA Study

Background: Studies on the temporal variation in stroke incidence have reported inconsistent results. Few have studied the temporal variations in case fatality. No study on incidence and case fatality of stroke by season in Sweden has been found. This study explores the weekly, monthly and seasonal variations in incidence and 28-day case fatality of stroke. Methods: A total of 7,129 patients with first-ever stroke during the period 1989–1999 were retrieved from the Stroke Register of Malmö, Sweden. χ² test was performed to test the seasonal differences and Poisson regression analysis was used to calculate the case fatality ratios adjusted for sex and age. Results: The stroke cases were on the whole randomly distributed over the study period of 4,017 days. Incidence of all types of stroke, intracerebral hemorrhage and subarachnoid hemorrhage showed no variation by season, month or weekday, but incidence of cerebral infarction for the total population was higher in autumn and winter. Twenty-eight-day case fatality (930 fatal events, 13%) clustered significantly over the study period. Winter emerged as the peak season among men (12.5%), women (17.2%) and total population (15.1%). No consistent variation of incidence and case fatality of stroke by month or weekday was found. Conclusion: Case fatality after stroke demonstrates a seasonal variation with a peak in winter. Incidence of stroke showed no consistent association with season, month or weekday.

Prospective community-based study of stroke in Northern Portugal: incidence and case fatality in rural and urban populations.

Mortality statistics indicate that Portugal has the highest stroke mortality in Western Europe. Data on stroke incidence in Northern Portugal, the region with the highest mortality, are lacking. This study was designed to determine stroke incidence and case fatality in rural and urban populations in Northern Portugal. All suspected first-ever-in-a-lifetime strokes occurring between October 1998 and September 2000 in 37,290 residents in rural municipalities and 86,023 living in the city of Porto were entered in a population-based registry. Standard definitions and comprehensive sources of information were used for identification of patients who were followed-up at 3 and 12 months after onset of symptoms. During a 24-month period, 688 patients with a first-ever stroke were registered, 226 in rural and 462 in urban areas. The crude annual incidence was 3.05 (95% CI, 2.65 to 3.44) and 2.69 per 1000 (95% CI, 2.44 to 2.93) for rural and urban populations, respectively; the corresponding rates adjusted to the European standard population were 2.02 (95% CI, 1.69 to 2.34) and 1.73 (95% CI, 1.53 to 1.92). Age-specific incidence followed different patterns in rural and urban populations, reaching major discrepancy for those 75 to 84 years old, 20.2 (95% CI, 16.1 to 25.0) and 10.9 (95% CI, 9.0 to 12.8), respectively. Case fatality at 28 days was 14.6% (95% CI, 10.2 to 19.3) in rural and 16.9% (95% CI, 13.7 to 20.6) in urban areas. Stroke incidence in rural and urban Northern Portugal is high compared to that reported in other Western Europe regions. The high official mortality in our country, which could be explained by a relatively high incidence, was not because of a high case fatality rate.

Homogeneity of large and small vessel disease over time: Arguments from a study on recurrent stroke in 998 patients with first cerebral infarct

Background: Data on subtype and location of recurrent stroke after a first cerebral infarct may be relevant for prognosis and for understanding progression of the vascular disease underlying stroke subtypes over time. Therefore, we studied 30-day case fatality, stroke subtype, and stroke location in first and recurrent stroke, accounting for stroke subtype. Methods: We conducted a cross-sectional follow-up of 998 patients with first cerebral infarct registered in a hospital-based stroke registry. Results: After a follow-up of 691 ± 521 (SD) days, there were 138 (13.8%) first recurrent strokes, 84 (61%) of which had computed tomography. Recurrent stroke was of the same subtype as the first stroke in 27 (57%) of 339 lacunar, 38 (83%) of 435 atherothrombotic, and 33 (94%) of 224 cardioembolic cerebral infarcts. The annual stroke recurrence rate was about 7% for the whole group. Logistic regression analysis showed lacunar first stroke and hypertension as independent predictors for recurrent lacunar stroke, and atherothrombotic first stroke type for recurrent atherothrombotic stroke. Stroke recurrences that were of the same type as the first stroke occurred in the same brain area as the first stroke in 70% of lacunar and 79% of atherothrombotic cases. This was more frequent when compared with nonsimilar recurrence types: odds ratio (OR) 4.38, 95% confidence interval (CI) 1.09–15.79; and OR 5.63, 95% CI 1.38–22.92, respectively. Only 33% of cardioembolic recurrent strokes occurred in the same area. The 30-day case fatality in index and recurrent stroke was, respectively, 2% and 14% (OR 7.90, 95% CI 2.78–22.48) for lacunar, 10% and 26% (OR 3.27, 95% CI 1.62–6.60) for atherothrombotic, and 23% and 31% (OR 1.47, 95% CI 0.55–3.93) for cardioembolic index infarcts. Conclusions: The annual stroke recurrence rate after a first brain infarcts is about 7%. Early case fatality after recurrent stroke is higher than after first stroke, with marked differences between stroke subtypes. Progression of small and large vessel disease, and the brain area of their location, are rather homogeneous over time.

Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study)

The incidence of stroke is predicted to rise because of the rapidly ageing population. However, over the past two decades, findings of randomised trials have identified several interventions that are effective in prevention of stroke. Reliable data on time-trends in stroke incidence, major risk factors, and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence. We aimed to obtain these data. We ascertained changes in incidence of transient ischaemic attack and stroke, risk factors, and premorbid use of preventive treatments from 1981-84 (Oxford Community Stroke Project; OCSP) to 2002-04 (Oxford Vascular Study; OXVASC). Of 476 patients with transient ischaemic attacks or strokes in OXVASC, 262 strokes and 93 transient ischaemic attacks were incident events. Despite more complete case-ascertainment than in OCSP, age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29% (relative incidence 0.71, 95% CI 0.61-0.83, p=0.0002). Incidence declined by more than 50% for primary intracerebral haemorrhage (0.47, 0.27-0.83, p=0.01) but was unchanged for subarachnoid haemorrhage (0.83, 0.44-1.57, p=0.57). Thus, although 28% more incident strokes (366 vs 286) were expected in OXVASC due to demographic change alone (33% increase in those aged 75 or older), the observed number fell (262 vs 286). Major reductions were recorded in mortality rates for incident stroke (0.63, 0.44-0.90, p=0.02) and in incidence of disabling or fatal stroke (0.60, 0.50-0.73, p<0.0001), but no change was seen in case-fatality due to incident stroke (17.2% vs 17.8%; age and sex adjusted relative risk 0.85, 95% CI 0.57-1.28, p=0.45). Comparison of premorbid risk factors revealed substantial reductions in the proportion of smokers, mean total cholesterol, and mean systolic and diastolic blood pressures and major increases in premorbid treatment with antiplatelet, lipid-lowering, and blood pressure lowering drugs (all p<0.0001). The age-specific incidence of major stroke in Oxfordshire has fallen by 40% over the past 20 years in association with increased use of preventive treatments and major reductions in premorbid risk factors.

Are changes in mortality from stroke caused by changes in stroke event rates or case fatality? Results from the WHO MONICA Project.

Mortality from stroke has been declining over recent decades in most countries, except in Eastern Europe. In this analysis, based on the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project, we explored to what extent these trends are due to changes in stroke event rate and to changes in case fatality. The WHO MONICA Project collected standardized data from 14 populations in 9 countries. All acute strokes occurring in men and women 35 to 64 years of age were included. Registration was carried out between 1982 and 1995, resulting in time spans from 7 to 13 years. Trends in event rates and case fatality were calculated as average annual percentage change. Up to 6-fold differences were observed in stroke mortality. Mortality declined in 8 of 14 populations in men and in 10 of 14 populations in women. An increase in mortality was observed in Eastern Europe. In the populations with a declining trend, about two thirds of the change could be attributed to a decline in case fatality. In populations with increasing mortality, the rise was explained by an increase in case fatality. In most populations, changes in stroke mortality, whether declining or increasing, were principally attributable to changes in case fatality rather than changes in event rates. Whether this was due to changes in the management of stroke or changes in disease severity cannot be established on the basis of these results.

Registration of Stroke through the Belgian Sentinel Network and Factors Influencing Stroke Mortality

Introduction: Stroke is one of the leading causes of death. Belgian stroke mortality rates are only available from the death certificates notification. Objectives: To estimate stroke incidence, mortality and case fatality, to compare our figures with those available from the death certificates notification and from neighboring countries, and identifying factors influencing survival. Methods: A nationwide prospective registration by 178 Belgian general practitioners recording all cerebrovascular events in 1998–1999. All events, including those for which medical care was immediately found in hospital, were included. Results: The yearly age-and-gender-adjusted stroke attack rates were estimated at 185 cases per 100,000 inhabitants (95% CI = 169–202). After 12 months, 47% of the patients died, resulting in an estimated yearly stroke mortality rate of 88 per 100,000 inhabitants (95% CI = 73–105). The case fatality rate among men (39%; 95% CI = 29–51) was lower than among women (50%; 95% CI = 39–63) (p < 0.05). In a forward stepwise logistic regression diabetes, stroke history, hemorrhagic stroke, coma, swallow deficit and urinary incontinence had a negative influence on stroke survival. Treated hypertension had a beneficial effect on survival. Conclusions: Stroke mortality rates estimated by the sentinel practices are fairly comparable with those based on the death certificates notification. The stroke attack rates correspond with those of neighboring countries. The role of treated hypertension on the outcome of strokes remains controversial in this registration.

Trends in stroke and coronary heart disease in the WHO MONICA Project.

Coronary heart disease (CHD) and stroke are leading causes of death and disability. Because they share major common risk factors, it would be expected that trends in mortality and incidence of these 2 major cardiovascular diseases would be similar. Data from the World Health Organization (WHO) Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project were used to compare 10-year trends in mortality, event rates, and case fatality from both CHD and stroke. Fifteen populations in the WHO MONICA Project provided data on both CHD (60 763 events) and stroke (10 442 events) in men and women aged 35 to 64 years (23.4 million person-years of observation in total). Trends for the 2 cardiovascular diseases varied within and between populations, and when data from all populations were combined, trends in CHD and stroke mortality differed in men (P=0.001) but not in women, whereas trends in event rates differed significantly in both men and women (P<0.001 and P=0.011, respectively). The differences in trends for CHD and stroke case fatality were not statistically significant in either men or women. In sensitivity analyses, differences in trends in event rates remained statistically significant in men (P<0.001) but not in women. Trends for CHD and stroke mortality rates, event rates, and case fatality differ substantially between and within the study populations.

Variation in the management of acute physiological parameters after ischaemic stroke: a European perspective.

Studies have shown significant variation in stroke case fatality across Europe. These variations suggest the need to explore whether differences in physiological support in acute stroke exist across Europe. Data were collected in four European centres over 6 months. These included clinical status and management of acute physiology (hydration, oxygenation, nutrition, hypertension, hyperglycaemia and temperature in the first week of ischaemic stroke) and survival at 3 months. Differences in acute supportive care between centres were adjusted for case mix. Patients admitted to centres in London (n = 106), Dijon (n = 95), Erlangen (n = 91) and Warsaw (n = 72) were studied. There were significant differences in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity between centres. After adjusting for case mix, there were significant differences in intravenous fluid use (P = 0.04), enteral feeding (P = 0.003), initiation of new antihypertensive therapy (P = 0.0006) and insulin therapy (P = 0.004) between centres, with the London centre having the lowest uptake of interventions. Three-month case fatality rates varied from 10 to 28%. This pilot study shows significant variation in acute physiological support in acute stroke across four European centres, which remains unexplained by case mix. Further research is required to link variation in acute care with stroke outcome, to identify which interventions appear to be the most effective.

Hypertension and clusters of risk factors in different stroke subtypes (an analysis of Hungarian patients via Budapest Stroke Data Bank).

Our aim was to determine the frequency of hypertension in the Hungarian stroke population, and to compare it with the data of other stroke registries. We attempted to find characteristic cluster-like associations between hypertension and another nine risk factors in different stroke subtypes and to ascertain the role of hypertension in leukoaraiosis, in early mortality, in stroke recurrence and in the case fatality rate up to 10 years. Risk factor profile of 500 unselected acute stroke cases of the Budapest Stroke Data Bank were analysed. We compared data of hypertensive stroke patients to those of unaffected ones. LIFEREG procedure of the SAS software package, cluster analysis, logistic regression, Pearson's correlation coefficient and Student's t-test were used as statistical methods. Hypertension was documented in 75% of the patients. The largest clusters were formed by the following groups: atherosclerotic stroke, hypertension with ischaemic heart disease; lacunar stroke and haemorrhage, hypertension with elevated serum cholesterol, cardiogenic embolism, ischaemic heart disease with atrial fibrillation. The case fatality rate was significantly higher in the group of hypertensive patients with ischaemic heart disease relative to those without it during the 10 years follow-up period. In the leukoaraiosis-group, systolic blood pressure was significantly higher than in the non-leukoaraiosis group. The rate of hypertension was higher than in other stroke registries. Hypertension appears to be the most frequent risk factor in stroke patients but case fatality rate is determined by presence or absence of ischaemic heart disease.

Stroke in Lund-Orup, Sweden: improved long-term survival among elderly stroke patients.

Several studies report declining early stroke case fatality, but the findings are not consistent across geographic areas. Corresponding changes in long-term survival are less well documented. We recently reported increased stroke incidence among patients aged <75 years and stable incidence among older persons. We now report temporal trends for early and late case fatality among patients with stroke onset during 1983-1985 and 1993- 1995. Patients living within the Lund-Orup, Sweden, hospital district and fulfilling the diagnostic criteria for first-ever stroke during 1983-1985 (n=998) and 1993-1995 (n=1318) were followed up concerning survival status at 28 days, 1 year, and 3 years. Age and sex adjustments were performed. The possible influence of Oxfordshire Community Stroke Project (OCSP) stroke subtypes on survival was also analyzed. Overall survival improved between the study periods (Cox proportional hazards regression: hazard ratio, 0.84; 95% confidence limits, 0.75 to 0.94; P=0.0019). The 28-day case fatality was 15% for stroke patients from both study periods. One-year case fatality was 31% for 1983-1985 patients and 27% for 1993-1995 patients. The corresponding figures at 3 years were 44% and 40%, respectively. In the group aged <75 years, there were no significant changes in overall survival, but survival improved significantly among patients aged > or = 75 years beyond 28 days after stroke onset. OCSP stroke subtype was an independent predictor of death (P<0.0001). The recently observed increase in stroke incidence among patients aged <75 years was not accompanied by changing survival in that age group. However, among patients aged > or =75 years, survival improved beyond 28 days after stroke. The causes of this change in survival are unknown but may be related to improved long-term care of elderly stroke patients.

Stroke Case Fatality in Denmark from 1977 to 1992: The Copenhagen City Heart Study

Background and Purpose: Stroke mortality rates have decreased in Denmark but little is known about the reasons for these changes. One possible explanation is decreased case-fatality, and the aim of the present investigation was to study trends in case-fatality for first-ever stroke in a large population-based cohort study in Copenhagen, Denmark. Subjects and Methods: The Copenhagen City Heart Study comprised 19,698 inhabitants in Copenhagen, Denmark. Linkage to two national registers enabled identification of all subjects irrespective of participation in the study examinations. Follow-up in the present study was from January 1, 1977 to December 31, 1992. Case fatality after 7 days, 28 days, 1 year and 1 year in 28-day survivors was assessed for first-ever stroke. Uniform identification and validation methods made it possible to estimate trends in case-fatality. The World Health Organization’s definition of stroke was used, and stroke was categorized into either unspecified stroke, ischemic infarction, intracerebral hemorrhage, or subarachnoid hemorrhage. The effect of time was estimated by means of multiple logistic regression analyses adjusting for gender, age at onset and type of stroke. Results: A total of 1,213 strokes occurred during the study period from 1977 to 1992 in the study population. The case-fatality was highest during the first 28 days, and especially the initial 7 days; thereafter a steady state was reached. From the period 1977–1980 to the period 1989–1992 case-fatality did not change in analyses of 7-day case-fatality odds ratio (OR) = 1.14 (95% confidence interval, CI: 0.98–1.33), or of 28-day case-fatality OR = 1.06 (95% CI: 0.92–1.20), or of 1-year case-fatality OR = 0.95 (95% CI: 0.84–1.07). In the 1-year case-fatality, including only 28-day survivors, a significant decrease was found OR = 0.81 (95% CI: 0.67–0.97). Men had a significantly lower 7-day case-fatality than women; OR = 0.73 (95% CI: 0.52–0.99), but the difference attenuated in subsequent analyses and did not remain statistically significant. Conclusion: During the period 1977–1992, the 1-year case-fatality decreased in stroke patients who survived the initial 28 days, whereas no changes were observed in 7-day, 28-day and 1-year case-fatality.

Stroke hospitalization and case-fatality in the United States, 1988–1997

23 Age-adjusted stroke mortality in the US has declined in recent decades. However, little is known about stroke morbidity. Using the National Hospital Discharge Survey data from 1988 to 1997, we examined the change in stroke hospitalization and case-fatality in the US. During the 10 years, age-adjusted stroke hospitalization rate increased 22% (from 381 to 463/100,000, p=0.048). By regions, stroke hospitalization rates overall were 641, 600, 562 and 438 for the South, Midwest, Northeast, and West respectively (p&lt;0.05), and were increased in all regions during the 10 years. Overall, 58% of stroke hospitalizations were due to ischemic stroke, 13% due to hemorrhagic stroke, and 29% were classified as other stroke. The hospitalization rates were 74.8 and 332.4 per 100,000 respectively for hemorrhagic and ischemic strokes and the increase rate in 10 years were 13.5% (p=0.214) and 31.5% (p=0.044) respectively. During 10 years, stroke patients with diabetes, hypertension and congestive heart failure increased 17.4% (p=0.17), 34% (p=0.05), and 31% (p=0.091) respectively. The average length of hospital stay reduced from 11.1 to 6.2 days (decrease of 44.1%), with an average annual percentage decrease of 6.1% (p=0.012). Although the total number of patients hospitalized for stroke increased during this period, the total person-days in hospital decreased 22% (p=006). In-hospital death among stroke decreased steadily from 12.7% to 7.6% (decrease of 40%, p=0.04). In-hospital case-fatality was estimated by stratifying patients on age, gender, region, type of stroke, and other co-morbidity. Case-fatality rate was substantially higher among patients with hemorrhagic than ischemic stroke (28.0% vs 5.8%, p&lt;0.01); among patients with congestive heart failure than those without (17.9% vs 8.5%). In addition, patients of old age (≥75 years), men, those living in the Northeast had higher case-fatality rates than those younger, women and living in elsewhere. In conclusion, the declining of age-adjusted stroke mortality in the US has not been found to be related to the decrease in incidence. However, the observed reduction in hospital case-fatality might contribute to the decline of stroke mortality.

Stroke hospitalization and case-fatality in the United States, 1988–1997

23 Age-adjusted stroke mortality in the US has declined in recent decades. However, little is known about stroke morbidity. Using the National Hospital Discharge Survey data from 1988 to 1997, we examined the change in stroke hospitalization and case-fatality in the US. During the 10 years, age-adjusted stroke hospitalization rate increased 22% (from 381 to 463/100,000, p=0.048). By regions, stroke hospitalization rates overall were 641, 600, 562 and 438 for the South, Midwest, Northeast, and West respectively (p<0.05), and were increased in all regions during the 10 years. Overall, 58% of stroke hospitalizations were due to ischemic stroke, 13% due to hemorrhagic stroke, and 29% were classified as other stroke. The hospitalization rates were 74.8 and 332.4 per 100,000 respectively for hemorrhagic and ischemic strokes and the increase rate in 10 years were 13.5% (p=0.214) and 31.5% (p=0.044) respectively. During 10 years, stroke patients with diabetes, hypertension and congestive heart failure increased 17.4% (p=0.17), 34% (p=0.05), and 31% (p=0.091) respectively. The average length of hospital stay reduced from 11.1 to 6.2 days (decrease of 44.1%), with an average annual percentage decrease of 6.1% (p=0.012). Although the total number of patients hospitalized for stroke increased during this period, the total person-days in hospital decreased 22% (p=006). In-hospital death among stroke decreased steadily from 12.7% to 7.6% (decrease of 40%, p=0.04). In-hospital case-fatality was estimated by stratifying patients on age, gender, region, type of stroke, and other co-morbidity. Case-fatality rate was substantially higher among patients with hemorrhagic than ischemic stroke (28.0% vs 5.8%, p<0.01); among patients with congestive heart failure than those without (17.9% vs 8.5%). In addition, patients of old age (≥75 years), men, those living in the Northeast had higher case-fatality rates than those younger, women and living in elsewhere. In conclusion, the declining of age-adjusted stroke mortality in the US has not been found to be related to the decrease in incidence. However, the observed reduction in hospital case-fatality might contribute to the decline of stroke mortality.

Trends in stroke incidence and acute case fatality in a Japanese rural area : the Oyabe study.

Stroke mortality in Japan has significantly declined during recent decades. To determine the cause of this decrease, we studied the trends in stroke incidence and case fatality within 28 days after stroke in a rural area in Japan. We used a population-based registry during 1977-1991 in Oyabe, a rural area in the central part of Japan. The average population aged 25 years and older numbered 32 859 persons. Changes in age-standardized stroke incidence rate were calculated and compared between the 3 periods 1977-1981, 1982-1986, and 1987-1991. The 28-day case fatality rate was evaluated and also compared between the 3 periods by onset year. The total number of strokes was 2068. The age-standardized incidence rate of all strokes decreased during the 15-year period, from 605 to 417 per 100 000 in men and from 476 to 329 per 100 000 in women. A marked decline was found during 1977-1986 but was not apparent during 1987-1991. Moreover, there was an increase in the group aged 75 years and older. The 28-day case fatality rates for all strokes improved from 18.0% to 14.2% in men and from 26.8% to 19.1% in women during the observation period. These data indicate that declines in the stroke incidence and the 28- day case fatality have been associated with a marked decrease in stroke-related mortality in Japan.

Stroke incidence and case fatality in Shiga, Japan 1989-1993.

This paper describes incidence rates and case-fatality for sub-types of stroke using data collected in Takashima, Shiga, Japan, from 1989 to 1993 and compares these with similar registers in other parts of Japan. Registered patients included all residents of the county who experienced a first-ever stroke. Stroke was defined as sudden onset of neurological symptoms which continued for a minimum of 24 hours or led to death. Almost all such patients are hospitalized in this country. Early case fatality was defined as patients who died within 28 days of stroke onset. Diagnosis of stroke type was based on clinical symptoms as well as computed tomography (CT) scans. Age-adjusted incidence rates for stroke per 100,000 population aged 35 years and older were 268.7 for men and 167.5 for women. The age-specific incidence rate of both cerebral infarction and cerebral haemorrhage increased with advancing age. The occurrence of cerebral infarction in men was twice as high as in women. The 28-day case fatality for all sub-types of stroke was 16.1% in men and 15.8% in women. Case fatality for cerebral infarction, cerebral haemorrhage, and subarachnoid haemorrhage was 10.7%, 22.4% and 28.6% respectively. Takashima County has a moderately high stroke incidence rate and case fatality compared with other similar studies in Japan. The incidence rate of cerebral infarction in men is twice that in women, while other sub-types of stroke showed smaller differences. In order to decrease the incidence of stroke in Japan, greater efforts at primary prevention will be necessary, in particular, it is important to prevent cerebral infarction in men.

A systematic review of vinpocetine therapy in acute ischaemic stroke.

To determine whether vinpocetine decreases short- and long-term case fatality and proportion of dependent survivors if administered within 2 weeks of stroke onset. All published and unpublished trials were attempted to be identified using the standard search strategy of the Cochrane Collaboration Stroke Review Group, using MEDLINE searches performed with all known manufacturer code names and trade names of vinpocetine and by contacting manufacturers of vinpocetine to give information of all randomised controlled trials on vinpocetine in stroke. Researchers who participated in trials on vinpocetine in Hungary were asked for further information. Only truly randomised, unconfounded clinical trials that compared the effect of vinpocetine to either placebo or another reference treatment for acute stroke where treatment started no later than 14 days after stroke onset were eligible for inclusion. Data synthesis and analysis was performed using the Cochrane Review Manager software (RevMan version 3.0). Among the identified studies on vinpocetine in stroke, only one fulfilled the selection criteria for inclusion in the review. No death occurred in the study groups and no statistically significant difference was found in dependency between the treatment and the placebo groups. No adverse effects were reported. Based on only one small randomised controlled unconfounded study, presently there is not enough evidence to decide whether the administration of vinpocetine does or does not decrease case fatality and dependency in acute stroke.

Seasonal variation in stroke mortality rates

To identify possible contributors to the seasonal variation in stroke mortality. Stroke and respiratory disease mortality rates were calculated from vital statistics and census data for the United States from 1938 to 1988. State-specific average temperatures by month were derived from data obtained from the National Climatic Data Center for 1938 to 1987. Each time series was decomposed into a trend, a seasonal effect, and a residual effect. Multiple regression was used to fit both a trend and a seasonal harmonic series. Cross-correlation was used to assess the relationship between the residual time series. There is a strong and consistent seasonal pattern of high stroke and respiratory disease mortality in the colder winter months. Stroke mortality was significantly and independently both positively associated with respiratory disease mortality and inversely associated with temperature. The sharp initial increases in both respiratory disease and stroke mortality in the late fall and early winter are synchronous, and the amplitudes are strongly associated, except for a saturation effect with extreme respiratory disease amplitudes. Seasonal change in stroke mortality is associated with seasonal variation in both respiratory disease and temperature. Respiratory disease and temperature may influence stroke mortality nonspuriously by affecting stroke case fatality, incidence, or both.

Epidemiology of stroke

Epidemiology of stroke

Stroke Incidence and Case Fatality in Two Populations: The Auckland Stroke Study and the Copenhagen City Heart Study

Comparison of stroke incidence and case fatality in different parts of the world provides information that may lead to a better understanding of the disease. In this report we have investigated these two aspects in two large populations, one in Auckland, New Zealand, and the other in Copenhagen, Denmark (the Copenhagen City Heart Study, CCHS). Incidence rates of stroke are higher for men than women in both studies. The stroke incidence rate ratios between Auckland men and CCHS men are significantly different in most age groups, whereas in women the incidence rates differ only in one age group. The age- and sex-adjusted incidence rates are higher in the CCHS for both men and women as compared to the Auckland Stroke Study. The age-adjusted incidence rate ratio is higher for men than women in both studies: 1.29 in the Auckland Stroke Study and 1.54 in the CCHS. The 28-day case fatality is also higher in the CCHS than in Auckland and is higher for women than men in both studies. The incidence rate of stroke and the 28-day case fatality is higher in the CCHS as compared to the Auckland Stroke Study in both men and women. A very high proportion of smokers in CCHS may explain some of the differences in incidence rates in the two populations.

Pathogenesis, Diagnosis and Epidemiology of Stroke

Stroke is the third leading cause of death, after cardiac disease and cancer, in most industrialised countries. Moreover, stroke is an important cause of long term disability and is the most common life-threatening neurological disease. During past years, there has been a declining trend in stroke incidence, mortality and case-fatality; the reasons for this are unclear and there is no evidence of the persistence of this favourable trend since 1980. The improved knowledge and, consequently, improved management of stroke risk factors and new trends in acute stroke treatment seem to account for this evolution. We present a review of stroke epidemiology, aetiology and emergency clinical and diagnostic aspects, paying particular attention to ischaemic strokes, which have been the subject of most of the research and clinical trials carried out in recent years. Moreover, we propose a brief guideline for diagnosis of stroke in the acute phase.