The burden, risk factors and unique etiologies of stroke in South-East Asia Region (SEAR)

Abstract

The World Health Organization (WHO) South East Asia Region (SEAR) comprises 11 countries, which are one of the most culturally, topographically, and socially diverse areas worldwide, undergoing an epidemiological transition towards non-communicable diseases, including stroke and other cardiovascular diseases (CVDs). This region accounts for over 40% of the global stroke mortality. Few well-designed population-based epidemiological studies on stroke are available from SEAR countries, with considerable variations among them. Ischemic stroke, a common stroke subtype, has higher frequencies of intracerebral hemorrhage in many countries. Along with an aging population, the increased prevalence of risk factors such as hypertension, diabetes mellitus, tobacco and alcohol consumption, lack of physical activity, high ambient pollution, heat, and humidity contribute to the high burden of stroke in this region. SEAR's many unique and uncommon stroke etiologies include cerebral venous thrombosis, tuberculosis, dengue, scrub typhus, falciparum malaria, snake bite, scorpion sting, etc. Current data on stroke burden and risk factors is lacking, compelling an urgent need for high-quality hospital-level and population-level data in all SEAR countries. Strategies towards a consolidated approach for implementing improved stroke prevention measures, stroke surveillance, and established stroke systems of care are the path to bridging the gaps in stroke care.

Keywords: Stroke burden; Stroke risk factors; Unique etiologies.

Fig. 1

37-year-old gentleman who presented with acute onset incoherent speech and new onset headache of 1 day duration along with 1 episode of generalized tonic clonic seizures. There was a history of binge intake of alcohol prior to the episode. Non-contrast CT head reveals a hemorrhagic infarct in right temporoparietal region (A). MRI brain (B–E) shows heterogenous hyperdensity in the right temporoparietal region with hypodense areas. MR venogram (E) demonstrating lack of flow in the right transverse sinus.

Fig. 2

Shows common risk factors for cerebral venous sinus thrombosis in Southeast Asiaregion.

Fig. 3

26-year-old male who presented with acute onset of inability to speak, left hemiparesis of 6 h duration with drowsiness. There was a history of loss of weight and appetite with generalized weakness of 2 months. MRI Brain revealed an area of true restriction in the right internal capsule of diffusion weighted images suggestive of an infarct. Patient underwent CSF examination which showed pleocytosis with 800 white blood cells (polymorphs 65%, lymphocytes 35%), raised proteins (120 mgs) and very low sugar levels (40 mgs). A TB PCR for Mycobacterium Tuberculosis was found positive on the CSF. He was further evaluated for an immunocompromised state and was found to be positive for HIV by Elisa and Western Blot assays.