Scientific article
Letter
OA Policy
English

Ischemic stroke of unclear aetiology: a case-by-case analysis and call for a multi-professional predictive, preventive and personalised approach

Published inThe EPMA journal
Publication date2022-11-17
First online date2022-11-17
Abstract

Due to the reactive medical approach applied to disease management, stroke has reached an epidemic scale worldwide. In 2019, the global stroke prevalence was 101.5 million people, wherefrom 77.2 million (about 76%) suffered from ischemic stroke; 20.7 and 8.4 million suffered from intracerebral and subarachnoid haemorrhage, respectively. Globally in the year 2019 - 3.3, 2.9 and 0.4 million individuals died of ischemic stroke, intracerebral and subarachnoid haemorrhage, respectively. During the last three decades, the absolute number of cases increased substantially. The current prevalence of stroke is 110 million patients worldwide with more than 60% below the age of 70 years. Prognoses by the World Stroke Organisation are pessimistic: globally, it is predicted that 1 in 4 adults over the age of 25 will suffer stroke in their lifetime. Although age is the best known contributing factor, over 16% of all strokes occur in teenagers and young adults aged 15-49 years and the incidence trend in this population is increasing. The corresponding socio-economic burden of stroke, which is the leading cause of disability, is enormous. Global costs of stroke are estimated at 721 billion US dollars, which is 0.66% of the global GDP. Clinically manifested strokes are only the "tip of the iceberg": it is estimated that the total number of stroke patients is about 14 times greater than the currently applied reactive medical approach is capable to identify and manage. Specifically, lacunar stroke (LS), which is characteristic for silent brain infarction, represents up to 30% of all ischemic strokes. Silent LS, which is diagnosed mainly by routine health check-up and autopsy in individuals without stroke history, has a reported prevalence of silent brain infarction up to 55% in the investigated populations. To this end, silent brain infarction is an independent predictor of ischemic stroke. [...]

Keywords
  • Blood pressure
  • Blood–brain barrier breakdown
  • Body mass index
  • COVID-19
  • Cancer
  • Coagulation
  • Connective tissue impairments
  • Diabetes comorbidities
  • Endothelial dysfunction
  • Endothelin-1
  • Flammer Syndrome phenotype
  • Health policy
  • Health risk assessment
  • Health-to-disease transition
  • Hypoxia-reperfusion
  • Individualised protection
  • Ischemic stroke
  • Lacunar stroke
  • Mental health
  • Metastasis
  • Normal-tension glaucoma
  • Optic nerve degeneration
  • Paradigm change
  • Pre-pregnancy check-up
  • Predictive preventive personalised medicine (PPPM / 3PM)
  • Primary care
  • Pro-inflammation
  • Retinal microvascular abnormalities
  • Screening
  • Secondary care
  • Silent brain infarct
  • Small vessel disease
  • Stress
  • Sub-optimal health
  • Systemic effects
  • Thromboembolism
  • Vascular stiffness
  • Vasospasm
  • Young populations
Citation (ISO format)
GOLUBNITSCHAJA, Olga et al. Ischemic stroke of unclear aetiology: a case-by-case analysis and call for a multi-professional predictive, preventive and personalised approach. In: The EPMA journal, 2022. doi: 10.1007/s13167-022-00307-z
Main files (1)
Article (Published version)
Identifiers
Additional URL for this publicationhttps://link.springer.com/10.1007/s13167-022-00307-z
Journal ISSN1878-5077
292views
129downloads

Technical informations

Creation23/11/2022 16:08:00
First validation23/11/2022 16:08:00
Update time16/03/2023 09:05:23
Status update16/03/2023 09:05:21
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