Etiological and Risk Factor profile of Stroke in Young Serving Soldiers at High Altitude

Dr Amit Sreen; Dr K S Brar; Dr Naresh Bansal

Volume : VIII, Issue : V, May - 2019

Etiological and Risk Factor profile of Stroke in Young Serving Soldiers at High Altitude

Dr Amit Sreen, Dr K S Brar, Dr Naresh Bansal

Abstract :

Background / Introduction: Stroke is major cause of morbidity and mortality and its affliction of young serving soldiers posted at high altitude merits special attention in diagnostic, therapeutic and preventive care. Besides, it leaves these patients with residual disabilities like physical dependence, cognitive decline, depression and seizures and enormous socio – economic burden to meet the costs of rehabilitation of “stroke victims”. Cereal venous thrombosis and rheumatic heart disease are, in general, the leading causes of stroke in the young besides other conditions like tubercular meningitis, autoimmune angitis, coagulopathy, elevated lipoprotein (a), homocysteine, and elevated anti cardiolipin antibodies. Cereal venous thrombosis in peripheral and splanchnic veins and arterial thrombosis in coronary, mesenteric and cereal vessels can occur in troops, weeks after their arrival at high altitudes suggesting role of increased viscosity, secondary to raised hematocrit and dehydration and hypoxia in causation of strokes in young previously healthy serving soldiers. Aim of the Study: This study aims to analyse the etiology and risk factor profile of young serving soldiers with stroke referred to tertiary care hospital. Methods: This is an analysis of young apparently healthy serving soldiers (n = 33) who had suffered a Stroke at high altitude over a period of observation of 3 years. They underwent a detailed general and neurological examination following which underwent the following investigations: complete hemogram, blood sugar levels (fasting and post prandial), lipid profile (12–hour fasting state), and other metabolic parameters. All patients were subjected to chest radiography (for any evidence of cardiomegaly), 12 lead ECG, and 2D echocardiography to detect cardiac abnormalities. Neuroimaging (non–contrast CT head) was performed in all and CT Angiography was done in selected cases. They were further screened for procoagulant profile, encompassing protein C, protein S, antithrombin III assays, factor V leiden, and antiphospholipid antibodies. Serum homocysteine levels were also evaluated, along with vasculitic screening and trans oesophageal echocardiography. Results: The most common etiological cause for Stroke in young apparently healthy soldiers at high altitude was found to be venous infarction followed by cardio embolic stroke. 12 patients (36.36%) had arterial infarcts, 19 patients (57.57%) had venous infarcts, while 2 patients (6.06%) had ICH. Our study showed protein S deficiency to be the most common cause of venous infarction (26.82%) followed by protein C deficiency (21.95%) possibly contributed by hypobaric hypoxia with sedentary lifestyle and dehydration increasing risk of venous thrombus. Conclusions: Stroke in young serving soldiers is caused mostly by venous infarction secondary to an underlying procoagulant state with Protein C and S deficiency being the most common cause