Early ischemic stroke presentation in Pakistan.
BACKGROUND
There are no studies from Pakistan that describe stroke presentation rates or factors associated with early or delayed presentation. This is important to know because current clinical protocols limit the use of recombinant tissue plasminogen activator (rtPA), the only available therapy for acute ischemic stroke, to a three-hour window from symptom onset.


METHODS
All patients aged 14 years or above with acute ischemic stroke of < or = 48 hours duration were prospectively identified from the Aga Khan University Stroke Data Bank over a 22-month period ending May 2001.


RESULTS
269 ischemic stroke patients presented within 48 hours of stroke onset. 55 out of 269 (21%) presented within first three hours and 110 out of 269 (41%) within first six hours. Unawareness of treatment options (p < 0.001) and inappropriate diagnosis and field triage (p = 0.005) were associated with delayed presentation. Small vessel occlusion or lacunar stroke in the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) ischemic stroke subtype was associated with delayed presentation (p = 0.047) and cardioembolic stroke was associated with earlier presentation (p = 0.048). Stroke severity assessed with the National Institutes of Health Stroke Scale at a cut off score of > or = 15 was not associated with earlier time to presentation at three hours (p = 0.114) but there was some tendency at six hours (p = 0.097).


CONCLUSIONS
The rate of early stroke presentation in a Pakistani tertiary care facility is comparable to certain developed countries. To increase the proportion of patients who can benefit from thrombolytic therapy, programs need to be instituted to increase public awareness of treatment options for stroke and expedited referral by the primary care provider.
Kamal
Ayeesha Kamran
AK
Neurology Section, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Khealani
Bhojo Asumal
BA
Ansari
Sajjad Ahmed
SA
Afridi
Maria
M
Syed
Nadir Ali
NA
D000293:Adolescent; D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D020521:Stroke / Q000188:drug therapy; D013995:Time; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D010959:Tissue Plasminogen Activator