Epidemiology of stroke in Russia according to the results of the territorial-population register (2009-2010)

The population included in the study in 2009 was 1,864,932 people; in 2009, 3961 cases of stroke occurred in the study area, 1853 cases in men, which accounted for 47% of all stroke cases, and 2108 (53%) in women. The population included in the study in 2010 was 3,388,932 people; There were 8553 cases of stroke, 4038 (47%) in men, 4515 (53%) in women. The average age of stroke development was determined in the age range over 25 years and was 68.0 years in 2009, 64.9 years in men and 70.7 years in women. In 2010, the same figures were 66.7, 63.7 and 69.4 years, respectively. This is significantly lower than in Western populations (72.9 years in men and 77.7 years in women), but I would like to note that for the first time in the entire period of epidemiological studies of stroke in Russia middle age the development of stroke in 2009 exceeded the milestone of 70 years. In the United States, for example, less than 10% of deaths from circulatory system diseases occur under age 65; in Russia, according to government statistics, it is 30%. According to previously conducted registers, the average age of stroke development in Russia was 63.1 years for men and 66.3 years for women.

The absolute number of stroke cases in all study regions increased with age; the maximum number of strokes in men and women occurred at the ages of 61-63 years and 68-74 years; in the age group of 64-67 years, a sharp decrease in the number of strokes was registered (Fig. 1).

Figure 1. Number of stroke cases (x-axis) in men and women, all regions, 2010.

The decrease in the number of strokes in men and women aged 64-67 years is consistent with data from the Federal State Statistics Service (ROSSTAT) and is associated with a decrease in the population in this age group, which is caused by a sharp decrease in the birth rate during the Great Patriotic War (Fig. 2). This fact can serve as a criterion for good data reproducibility.

Figure 2. The size of the male and female population of Russia aged 25-99 years (as of January 1, 2002) according to ROSSTAT

The absolute number of strokes in patients under the age of 67 years is higher in men, and at older ages the incidence of stroke is higher in women, which is consistent with data from international studies.

Register data 2009-2010. showed that in Russia the main “contribution” to the prevalence of stroke was made by IS, which occurred 5 times more often than GI. The share of AI was 80.0% (80.3 and 79.5% for men and women, respectively) in 2009 and 81.4% (81.3, 82.3%) in 2010 (Table 1) . The proportion of HI, including intracerebral (ICH) and subarachnoid (SAH) hemorrhages, was 13% (13.0, 13.1%) in 2009 and 14% (14.9, 13.3%) in 2010.

Table 1.Prevalence of stroke of different types in men and women over the age of 25 in Russia, 2009-2010.

Type of stroke	Prevalence (% of all cases)
	2009		2010
	men	women	men	women

Note. SAH - subarachnoid hemorrhage, ICH - intracerebral hemorrhage, NI - undifferentiated stroke

In 2009-2010 There was significant variability in the prevalence of different types of stroke. For example, in 2010, a high prevalence of HI was registered among men in the Republic of Sakha (Yakutia); cases of SAH accounted for 3.36% of all cases, ICH - 25.17%, while in men of the Stavropol Territory there were no cases of SAH recorded throughout 2010, and ICH occurred only in 1.67% of cases.

However, despite the existing differences, in 2009-2010. in the vast majority of Russian territories, the ratio of AI and GI was 5:1.

It should be noted that in the register 2001-2003. Compared with data from previous studies, an increase in the relative number of cerebral hemorrhages was revealed - the ratio of AI to HI in 2001-2003. was 3.5:1 compared to 5:1 in 1970-1980. .

It can be assumed that the increase in the number of GIs at the turn of the century (register 2001-2003) was due to the complex economic situation in the country and, therefore, an insufficiently streamlined correction system arterial hypertension(AH), and a decrease in hemorrhages in 2009-2010. - expansion of preventive measures aimed at adequate correction of hypertension, expanding the possibilities of specialized care in the regions.

The prevalence of undifferentiated stroke (UI) in the Russian Federation was 7.07% (6.64, 7.45%) in 2009 and decreased by 1.5 times in 2010 - 4.58% (4.78, 4 .41%). In 2003, this figure was 12.26%.

The European standard stroke incidence rates in Russia in 2009 were 3.52 cases per 1000 population: 3.83 and 3.29 cases in men and women, respectively. In 2010, the incidence of stroke was slightly lower and amounted to 3.28 cases per 1000 population. It should be noted that in men the incidence increased by 8% compared to the previous year and amounted to 4.15 per 1000 population, and in women the incidence of stroke in 2010 was 2.74 per 1000 people, showing a record decline in recent decades - 17% (Table 2).

Table 2. European-standardized rates of stroke morbidity and mortality (men; women) in the Russian Federation, 2001-2003 and 2009-2010.

Epidemiological rate of stroke (per 1000 population per year)	2001	2002	2003	2009	2010
Morbidity	4,02 (4,25; 3,84)	3,80 (4,04; 3,60)		3,52 (3,83; 3,29)	3,28 (4,15; 2,74)
Mortality	1,47 (1,52; 1,41)	1,42 (1,57;1,30)	1,29 (1,48;1,21)	1,19 (1,13; 1,23)	0,96 (1,18; 0,81)

Over a 10-year period, the incidence decreased by 28%, from 4.02 in 2001 to 3.28 cases per 1000 population in 2010. At the same time, mortality within 28 days from the development of the disease decreased by 65% ​​and amounted to 1 .47 and 0.96 per 1000 population, respectively. This can serve as a criterion indicating an increase in the quality of provision medical care patients with stroke within the first 28 days from the onset of the disease. When comparing morbidity and mortality rates from stroke over the past decade, one can note a trend towards a decrease in epidemiological indicators of stroke, which has become more evident over the past year, which corresponds to the goals of the national project “Health”, adopted in 2009. However, epidemiological indicators of stroke remain more higher than in European countries. For example, in the registries of France, a country with a favorable situation regarding stroke, the incidence is 250 (231-269) cases per 100,000 population, and mortality rates have decreased by 2.5-2.9% per year.

Stroke incidence rates in 2009-2010. varied significantly in different regions Russian Federation. For example, in 2010, in one of the regions of Tatarstan (Chistopol) the incidence was 6.14 per 1000 population (7.89, 4.94), while in another region of Tatarstan (Nizhnekamsk) the incidence was high - 4.81 (5.54, 4.45), but significantly lower than in Chistopol. A high incidence was also recorded in the Arkhangelsk region - 5.16 (6.92, 4.17).

In 2010, low incidence rates were in the Republic of Dagestan (Makhachkala) - 2.18 per 1000 (2.51, 1.92); for 2 years, low rates remained stable in the Altai Territory - 1.39 per 1000 (2.15, 0.94) in 2010 and 2.04 (2.3, 1.86) in 2009 (Fig. 3).

Figure 3. European-standardized rates of stroke incidence and mortality from stroke in Russia, 2010 (per 1000 population).

In 1985-1995 As part of the international study of stroke using the MONICA registry method, studies were conducted in Russia that showed a clear trend towards an increase in incidence from the west (Novosibirsk) to the east (Tynda and Anadyr), as well as an increase in the proportion of patients with GI from west to east. In studies of 2001-2003 and 2009-2010. this pattern is no longer visible, which is probably due to the organized work of regional vascular centers throughout the Russian Federation.

The incidence of primary strokes was 2.6 times higher than the incidence of recurrent strokes in 2009 and 2.8 times higher in 2010 (Table 3). The incidence of recurrent strokes reflects the structure of the incidence of primary strokes and was higher in men in all age groups. The ratio of primary and recurrent stroke cases during 2009-2010. for men it was 3:1, for women - 3.5:1.

Table 3. European-standardized incidence rates of primary and recurrent strokes and mortality from primary and recurrent strokes in Russia, 2009-2010.

Floor	2009				2010
			lethality, %		incidence per 1000 population		lethality, %
	Primary stroke	Repeated stroke	Primary stroke	Repeated stroke	Primary stroke	Repeated stroke	Primary stroke	Repeated stroke
All patients	2,62	1,01	25,4	23,6	2,46	0,89	21,4	23,2
Men	3,69	0,90	20,7	25,0	3,15	1,01	19,6	24,5
Women	6,52	0,74	29,3	22,3	2,81	0,79	23,0	22,0

International studies show that recurrent strokes develop more often than primary strokes in patients with hypertension with higher blood pressure levels and the presence of hypertensive cerebral crises and transient ischemic attacks. The prevalence of hypertension in men who had a stroke was 97.3% in 2009, and 95.8% in women; in 2010 - 97.5% for men and 94.8% for women.

The mortality rate for primary strokes in 2009 was 25.4%, in 2010 - 21.4%, for recurrent strokes - 23.6 and 23.2% in 2009-2010. respectively.

In most regions, standardized morbidity and mortality rates correlated with each other, i.e. in regions with relatively high morbidity there was also high mortality (for example, Sverdlovsk and Irkutsk regions, the Republic of Sakha), and in regions with the lowest morbidity the lowest mortality was recorded (Republic of Dagestan, Altai Territory, Orenburg Region).

It should be noted that in some territories this trend did not persist. For example, in 2009, the leading mortality rates were in the Stavropol Territory, with relatively low morbidity rates. This situation is largely due to the fact that in the Stavropol Territory most of the population belongs to older age groups, and the average age of stroke is 75.2 years (68.7 years for men and 75.4 years for women). It is in the Stavropol Territory that the lowest incidence rates of HI were registered, the incidence rate of ICH was 0.17 per 1000 population (0.18, 0.15), SAH - 0.04 (0.02, 0.06); a similar trend continued in 2010, and during the period of 2010 not a single case of SAH was registered. A similar situation was recorded in the Krasnodar Territory (Krasnodar) in the 2001-2003 register, adjacent to the Stavropol Territory, with similar climatic and geographical characteristics.

In another case, with a very high incidence of acute cerebrovascular accidents in the Republic of Tatarstan (Chistopol) in 2010 - 5.15 per 1000 (6.61, 4.65) - the average mortality rate for the Russian Federation was recorded - 0.91 per 1000 population (1.28, 0.69).

In the vast majority of regions, epidemiological rates of stroke in men were higher than in women. For example, in 2010, morbidity rates for men in the Ivanovo, Sakhalin regions and the Republic of Bashkiria were almost 2 times higher than for women in the Republic of Sakha (Yakutia), Orenburg and Irkutsk regions, and the mortality rate for men in these regions was 1 .5 times higher than in women. The most pronounced differences in stroke incidence rates between men and women were noted in young and middle age. In the age groups 45-49, 50-54 and 55-59 years, the incidence in men was 1.8-2.2 times higher than in women. For example, the incidence of stroke in men 55-59 years old was 0.85, and in women - 0.40 cases per 1000 population. Thus, the age group of 45-59 years in men remains the most dangerous in terms of the occurrence of a primary stroke, which is consistent with studies of past years and, accordingly, special attention should be paid to this age category when carrying out preventive measures.

As age increased, rates in men remained higher than in women, but the differences were not as pronounced. Only at the age of 80 years and older was the incidence higher in women. This situation is observed in a number of European registries, such as the one conducted in Denmark.

The mortality rate in patients with stroke during the first 28 days from the onset of the disease was 24.9% in 2009 (in men - 21.9%; in women - 27.6%); in 2010 - 22.47% (20.41 and 24.32%, respectively). These figures are significantly lower than in the registers of previous decades, for example in 2001 - 40.37% (36.6% for men and 43.4% for women).

The highest mortality rates were recorded in men and women in the Stavropol Territory - 44.9% (36.3 and 51.7%), the minimum in the Krasnoyarsk Territory - 10.9% (13.9 and 8.7%) (Table .4).

Table 4. Mortality rates from stroke (in%) in different regions of the Russian Federation, 2009-2010.

Region	2009			2010
	all patients	men	women	all patients	men	women
Altai region
Voronezh region
Ivanovo region
Irkutsk region
Sverdlovsk region
Sakhalin region
Stavropol region
Republic of Bashkiria
Republic of Karelia
Krasnoyarsk region
Arkhangelsk region
Republic of Dagestan
Republic of Sakha (Yakutia)
Republic of Tatarstan
Nizhnekamsk, Tatarstan
Chistopol, Tatarstan
Orenburg region

A decrease in the overall mortality rate was observed in 2010 compared to 2009 in the Ivanovo, Sakhalin regions, Stavropol Territory and the Republic of Bashkiria.

The mortality rate in men decreased within 2 years in most regions with the exception of the Voronezh and Sverdlovsk regions; in women there was also a decrease in mortality in most regions with the exception of the Voronezh, Ivanovo regions and Altai Territory.

Case fatality rates varied across regions of the country, but the differences in case fatality rates were significantly smaller than in previous studies. This may indicate an improvement in the organization of medical care in regions, including remote ones, and an increase in the percentage of patients treated in a hospital.

In case of fatal stroke, the maximum mortality rate is observed in the first days of stroke development and decreases within 28 days.

The proportion of stroke patients receiving treatment in a hospital in 2010 was 79.81% (78.05 and 78.58%) (Table 5). Just 10 years ago, only about 60% of stroke patients could receive hospital care (from 38.5 to 81.1% in different cities). In the 1980s, the number of stroke patients treated in hospital was even lower. Thus, in the 80s, 37% of patients were hospitalized in Leningrad, in the cities of the Vladimir region - 35%, in Novosibirsk - 52%, in Krasnoyarsk - 36%, in Tynda - 71%, while it was also noted that the mortality rate in the hospital was lower than with home treatment.

Table 5. Hospitalization of stroke patients in 2010 (all stroke cases, %)

Region	All patients	Men	Women
Arkhangelsk region
Altai region
Republic of Bashkiria
Ivanovo region
Irkutsk region
Sverdlovsk region
Republic of Dagestan
Orenburg region
Sakhalin region
Stavropol region
Republic of Tatarstan
Republic of Sakha (Yakutia)

According to European registers, in the 80s of the last century the hospitalization rate in Sweden (Gothenburg) was 88%, in Denmark (Copenhagen) - 79%, in Ireland (Dublin) - 74%, in Finland (Espoo) - 70%, in Yugoslavia (Zagreb) - 83%, in Israel (Zerifin) - 75%. Currently, in economically developed countries of Europe, Japan, and the USA, 93-96% of stroke patients are hospitalized.

Neuroimaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), were used to differentiate the nature of stroke in 63.1% of stroke patients in 2009 and 74.2% in 2010.

It should be noted that according to the 2001-2003 registry, the use of CT and MRI was noted in no more than 20% of stroke cases, even in large cities.

According to the outlined plans, the second large-scale study of stroke using the registry method is being conducted on the territory of the Russian Federation. Reliable data on the main epidemiological indicators of stroke have been obtained; it is possible to compare stroke indicators over time and evaluate the effectiveness of treatment and preventive measures widely carried out in the country.

To assess the dynamics of the main epidemiological parameters, the study according to the unified register program will continue for 5 years, until 2013. This is an energy-intensive and creative work, requiring careful implementation, the results of which become visible after years, but their significance cannot be overestimated. Obtaining reliable statistical data will make it possible to adequately plan the volume of medical care to the population, reduce morbidity and disability, and improve the quality and life expectancy of the population.

Federal State Budgetary Institution "Research Institute of Cerebrovascular Pathology and Stroke", Moscow
GBUZSK "Stavropol Regional Clinical Center for Specialized Types of Medical Care", Stavropol
Federal State Budgetary Institution "Research Institute of Cerebrovascular Pathology and Stroke", Moscow
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The team of authors expresses sincere gratitude to the heads of regional vascular centers who performed great and responsible work, as well as to all officials who assisted in conducting the study.

Navigation

The causes leading to acute cerebrovascular accident (ACVA) are diverse:

• stress;
• hereditary predisposition;
• drinking alcohol;
• smoking;
• unhealthy diet (abundance of animal fats, salt);
• cardiovascular diseases (hypertension, atherosclerosis, atrial fibrillation, angina pectoris);
• other diseases (diabetes, obesity);
• congenital vascular pathology (AVM, vascular aneurysms);
• sedentary lifestyle;
• age-related changes in blood vessels;
• hormonal imbalance (during menopause in women, the level of estrogen that protects blood vessels decreases).

Death from stroke can occur both in the early post-stroke period and during the process of rehabilitation from hemorrhage.

Stroke mortality statistics

Hemorrhagic (20%) and ischemic (or cerebral infarction, accounting for 80% of cases) variants of stroke are possible. The likelihood of death in the acute period increases with the hemorrhagic form.

Mortality rates from stroke directly depend on its type, as well as on the stage of the disease, gender and age of the patient, the presence of concomitant pathology, general condition, timeliness and completeness of medical care.

According to statistics in Russia, the mortality rate for intracerebral hemorrhages is higher than for subarachnoid forms. Older patients have a higher mortality rate. Women die from stroke 10% more often than men.

World statistics

In the ischemic form, death from stroke occurs more often with atherothombotic, cardioembolic or hemodynamic variants of stroke. Lacunar or microocclusive strokes are rarely associated with mortality.

A high percentage of mortality is observed from massive or repeated cerebral hemorrhage. The third stroke is often the last. With a major stroke or cerebral infarction, severe irreversible consequences occur and the chances of survival are reduced.

An unfavorable prognosis appears when the centers regulating respiration and cardiac activity are involved in the pathological process. This occurs due to the death of neurons in the brainstem or cerebellum. Due to cardiac and respiratory arrest, the person dies.

Clinic

The left hemisphere coordinates the right half of the body and is responsible for analytical abilities, thinking, and speech.

Extensive ischemic stroke of the left side appears with the following pathological changes:

• paresis, paralysis on the right;
• visual impairment in the right eye;
• motor aphasia (difficulty pronouncing speech);
• sensory aphasia (inability to understand someone else's speech);
• impairment of cognitive functions and logical thinking;
• mental changes.

It is believed that patients with strokes on the left side respond better to treatment.

When the right hemisphere is damaged, the following occurs:

• left-sided paresis, paralysis;
• deterioration of short-term memory with preserved speech;
• emotional inadequacy;
• spatial orientation disorder.

Causes of mortality

The causes of damage to brain stem structures can be:

• hemorrhage in the cerebellum and brain stem;
• ischemia of deep brain structures;
• hemorrhage into the ventricles of the brain, causing tamponade of the spinal tracts, impaired circulation of cerebrospinal fluid, hydrocephalus, edema and displacement of the brain stem;
• cerebral edema causes dislocation of brain structures and herniation of the trunk into the foramen magnum of the skull.

The cause of death during a stroke may be concomitant pathology, such as myocardial infarction, pulmonary heart failure, and others.

Harbingers of death

There are prognostic adverse symptoms that indicate a high probability of patient death.

For example, with signs in the brainstem and cerebellum, the death of the patient occurs in 70-80%.

These are the symptoms:

• disorder of consciousness;
• early signs characteristic of ischemic stroke - loss of coordination, unsteadiness of gait, sweeping movements;
• the patient is unable to talk or move, he is only able to open and close his eyelids, the understanding of what is happening is preserved;
• impaired swallowing, this symptom is characteristic of stage 4 coma, the prognosis is unfavorable, mortality is 90%;
• no control over the movements of the arms and legs, lack of coordination of movements, muscle hypertonicity, convulsive twitching;
• hyperthermia over 40 0 ​​due to damage to the neurons responsible for thermoregulation, is difficult to respond to medications, a decrease in temperature can be achieved by infusion of chilled solutions, covering the head with cold;
• there is no synchrony of eye movements, their pendulum-like oscillations appear, the “doll’s eye” symptom;
• disturbance of hemodynamic parameters - high blood pressure, tachycardia, possibly arrhythmia, with the appearance of bradycardia the prognosis worsens even more;
• pathological types of breathing: Kussmaul (noisy, deep), Cheyne-Stokes (the appearance of deep breaths after shallow breathing), Biota (long breaks between breaths).

These signs before the death of the patient indicate the death of neurons in vital centers.

When a patient develops a coma, the chances of survival drop sharply; with a coma of 3-4 degrees, only 10% of patients remain alive. Patients who managed to survive a coma may die from complications characteristic of bedridden patients.

Here is their list:

• bedsores;
• congestive pneumonia;
• pulmonary embolism;
• genitourinary sepsis;
• renal failure, dehydration.

Prevention of these complications should begin from the moment of hemorrhage and continue during the rehabilitation process.

Life support equipment

If a comatose patient is on a ventilator for a long time, the decision to disconnect the device is made by a committee with the consent of the relatives. Statistics in Russia show that after 4 months of being in a coma after a stroke, only a few can come out of it. With adequate care, it is possible to extend the life of such patients for several years.

Signs of death

If the patient died from a stroke, then there are signs by which death can be ascertained from the first minutes of its onset:

• no reaction to any stimuli;
• loss of reflexes, including corneal reflexes, dilation of the pupils, lack of their reaction to light;
• cat's eye symptom (when the eyeball is compressed, the pupil becomes oval), clouding and drying of the cornea;
• lack of breathing, heartbeat.

When signs of clinical death appear, resuscitation measures are indicated. They should be started immediately, since after 5-10 minutes irreversible death of brain cells occurs, without the possibility of their restoration.

If resuscitation was not effective, then signs of biological death appear:

• drop in body temperature;
• cadaveric spots;
• rigor mortis;
• tissue decomposition.

Statistics for Russia

Death after a stroke can be due to various reasons. Mortality prevention is aimed at preventing cerebral hemorrhage, which is the second leading cause of death in Russia.

Stroke is a pathology that is currently epidemic. The number of attacks increases several times every year. The consequences of a stroke are almost always negative - they are either serious complications of life or death.

According to the World Health Organization, one person dies from a stroke every 6 seconds. Unfortunately, on at the moment questions: what is death from a stroke, what does it look like and what a patient can feel do not lose relevance, but are widespread.

Some world statistics

Stroke is one of the truly dangerous diseases, which annually occupies a leading position in mortality. According to unofficial data, every 2-3 seconds one person in the world suffers an attack.

A few decades ago, the disease was considered age-related. Stroke in at a young age was considered the exception, not the rule. However, at the moment, the pathology has not only become more “younger”, but even children are dying from strokes.

The main danger of a stroke is that the attack is sudden and the symptoms clearly appear when large-scale brain damage begins. Time and competence in emergency care play a huge role.

Providing assistance

Important! Timely treatment to the hospital and comprehensive medical interventions reduce the risk of a recurrent attack and can prevent the death of the patient.

What's happening in Russia?

According to medical data, 450,000 people suffer ischemic or hemorrhagic stroke per year. Stroke and mortality are two inseparable concepts, since every year the number of fatal attacks grows exponentially.

According to official WHO data, Russia is annually on the list of leaders in the number of deaths.

A larger percentage of patients are women. This is due to the fact that female body copes much worse with hemorrhages or brain hypoxia. In men, survival and the chance of a positive prognosis for rehabilitation after illness are 10 percent higher.

Doctors note several more factors that characterize attacks in Russia:

• The percentage of people who have had a stroke to the healthy population is much higher in large cities. Leaders at the moment: Moscow and St. Petersburg. The number of patients in the capital for 20 years has been 36,000 – an absolute negative record. In St. Petersburg, the number of patients reaches 25 thousand.
• The number of instant deaths is 15%.
• More than half of the attacks occur in the ischemic form and only 20% in the hemorrhagic form.

Schedule

As of 2017, the number of deaths from stroke, as well as the number of attacks, has decreased.

• Over the past few years, the number of strokes has increased, outpacing myocardial infarction, which has been one of the most common diseases for a long period of time.

In the coming years, data on stroke will only increase. Experts explain this by the fact that the young part of the population, for the most part, does not healthy image life, abuses bad habits and avoids physical activity.

Pay attention! Sport, healthy eating, eliminating alcohol, cigarettes and drugs reduces the risk of pathological conditions of the cardiovascular system.

Gender data

Death from stroke is much higher among females. But men get sick 30% more often. Female mortality is 50%, male mortality is 40%.

The reason lies in frequent hormonal disruptions in the body of women, and the fact that stroke affects older people over 65 years of age. And at this age the percentage of women is higher.

Risk zone – who is in it?

To avoid the question: “can you die from a stroke?” it is necessary to understand who is at risk and what factors influence the development of pathology. And if you notice such signs in yourself or your loved ones, be sure to register with the hospital and pay close attention to your health.

Factors that increase the risk of stroke:

• sudden, intense changes in blood pressure;
• genetic predisposition to cardiovascular pathologies;
• excess body weight;
• hypertension;
• endocrine pathologies, in particular diabetes mellitus;
• atherosclerosis;
• increased cholesterol levels in the blood;
• smoking and alcohol abuse;
• sedentary lifestyle;
• vascular dystonia of the brain or VSD;
• atrial fibrillation.

How to avoid a stroke - recommendations

If the above conditions are present, it is necessary to undergo regular preventive examinations.

Which form is more dangerous?

Stroke is divided into two types: hemorrhagic and ischemic. The latter is more common. In this case, blood flow to the brain is disrupted, causing hypoxia and cell death.

Hemorrhagic stroke is less common, but the mortality rate is much higher. With such an attack, bleeding occurs in the brain. Most often, a person who has suffered such a stroke dies on the first day.

The risk of an unfavorable outcome increases sharply with a second attack or with a major stroke. People who have suffered a brainstem stroke have a negative prognosis: damage to the cerebellum or midbrain. In this case, there is a high possibility of cell death in the sections that regulate respiration and heart function. A person may die from cardiac or respiratory arrest.

Important! Everyone needs to know the main symptoms of a stroke; if it occurs in a loved one or passerby, seek medical help as soon as possible.

How long does it take for pathology to lead to death?

One of the questions asked by loved ones of a person who has suffered a stroke and has virtually no chance of survival is: “how long does it take to die from a stroke?” At the same time, no specialist can answer this question unambiguously, since everything depends on age, the extent of the lesion and individual characteristics body.

If the patient is in a coma, then his chances are reduced. However, there is a long-term comatose state from which a person can emerge even several years after the attack.

How long does the attack last?

The increase in risks and reduction in life expectancy is influenced by the development of complications:

1. pneumonia;
2. the formation of renal failure;
3. significant bedsores;
4. sepsis;
5. embolism of the pulmonary artery that forms against the background of ischemic stroke.

Emergence of data negative consequences indicates the patient's approaching death.

Signs of death from stroke

The risk of dying from an attack is high. Some patients die without regaining consciousness. To diagnose a fatal outcome, it is necessary to know the main signs of death in a bedridden patient after a stroke.

• Sleep increases, the patient can hear different voices and sounds.
• Blue spots form, initially on the lower extremities.
• The patient may feel heaviness and severe headache.
• Loss of coordination and orientation in space, consciousness can become significantly confused.
• The intensity of edema increases as a result of poor kidney function, and urine may become red.
• Unreasonable coldness in the extremities because blood flow stops.

A person in a coma has little chance of survival

These signs are harbingers of imminent death. The factors of death appear after a quarter of an hour. Among them:

1. a person stops responding to external stimuli: mechanical impacts on the cheeks, ammonia;
2. lack of pupillary reaction to light;
3. it is impossible to feel the pulse;
4. breathing is not recorded;
5. the cornea becomes cloudy.

Signs of death after 24 hours:

1. Drying of the skin and mucous membranes.
2. Corpse spots appear on the body, and rigor occurs.
3. Temperature drop to 20-25 degrees.

In most cases, death from this pathology occurs at night, much less often during the day. Many bedridden patients die without regaining consciousness. But it is possible to reduce the risk of a negative outcome. The main thing is to follow preventive measures and promptly seek emergency medical help.

Death from stroke is a real scourge of modern times. At the moment, such attacks occupy the third place in the number of deaths. At the same time, a stroke often occurs so quickly that loved ones can only wonder what a person feels when he dies from a stroke? To minimize the risk of developing pathology, it is necessary to monitor your health and lead a healthy lifestyle.

According to WHO, the incidence of strokes over the past ten years has increased from 1.5 to 5.1 per 1000 population. In the United States, stroke is the third leading cause of death, affecting 750 thousand people annually, 30% of whom die within the first year. In the UK, the incidence of stroke is 150 thousand cases per year, and mortality ranks third among other causes. Every year, about 5 million people worldwide die from cerebrovascular diseases (CVD), making stroke the second most common cause of death. Mortality from CVD is second only to mortality from heart disease and tumors of all locations and reaches 11-12% in economically developed countries. Along with high mortality, cerebrovascular accidents are the leading cause of disability in adults, causing up to 80% of partial and up to 10% of complete disability.

S.C. Johnston et al. (2009) performed a systematic review that analyzed stroke-related mortality and stroke-related DALYs (disability-adjusted life years) lost in 192 countries from different regions of the world. According to this analysis, there is a clear pattern between the low economic development of a country and the increasing medical and social burden of strokes in that country. At the same time, the differences between the “richer” and “poorer” countries reached 10-fold.

Mortality rates and DALYs due to stroke are highest in eastern Europe, northern Asia, central Africa and southern Oceania. Russia is in first place in terms of mortality from strokes out of the 192 countries studied (251 per 100 thousand population), Kyrgyzstan is in second (237 per 100 thousand population), and Seychelles is in last place (24 per 100 thousand population). Developed countries such as Australia, the USA, Canada, and Switzerland rank among the last (184th, 186th, 189th and 191st, respectively) because they had very low mortality rates from strokes (33 per 100 thousand population in Australia, 32 in the USA, 27 in Canada, 26 in Switzerland). The average mortality rate from strokes for all 192 countries was 111 per 100 thousand population. Approximately the same patterns were true for the DALY indicator.

Low national income per capita was found to be a strong predictor of mortality and DALYs lost from stroke (p Article navigation

A.A. Skoromets, V.V. Kovalchuk

EPIDEMIOLOGY OF VASCULAR DISEASES OF THE BRAIN

Vascular diseases of the brain (VCD) remain one of the most acute medical and social problems, causing enormous economic damage to society: they are the main cause of emergency hospitalization and long-term disability, occupying third, and according to some authors, second place among the causes of mortality in the adult population.

Studying the epidemiology of SHM is necessary for the successful operation of specialized services and the effective fight against this group of diseases.

The results of the first large-scale clinical and epidemiological study of strokes in St. Petersburg are reported by the Chief Neurologist of the Health Committee of the Administration of St. Petersburg, Corresponding Member of the Russian Academy of Medical Sciences, Honorable. Doctor of Sciences, manager Department of Neurology, St. Petersburg State Medical University named after. acad. I.P. Pavlova, dr med. sciences, professor Alexander Anisimovich Skoromets and head Department of Rehabilitation of Neurovascular Patients of Hospital N 38 named after. ON Semashko Vitaly Vladimirovich Kovalchuk.

Did you know that:

The prevalence of strokes in the world is 460-560 cases per 100 thousand population per year. Among economically developed countries, this figure is highest in Japan - 569 cases per 100 thousand per year, and the lowest in the UK and Scandinavian countries - 355-365, in Russia it is 1050;

the frequency of newly identified cases of acute stroke ranges from 100 to 200 per 100 thousand population per year. Among industrialized countries, this indicator is highest in Japan -213, and lowest in Canada, France, Denmark -120-125;

mortality rate from stroke in different countries fluctuates within fairly large limits. In 1990, in Eastern European countries it was 200-250 per 100 thousand population, and in Western European countries it was 100 per 100 thousand population. On average, in economically developed countries since 1970 there has been an annual decrease in the mortality rate from stroke by 7%. For example, in the USA over the past 10 years, mortality from this type of pathology has decreased by 50%.

At the time of the study, the incidence of strokes in St. Petersburg was 526 per 100 thousand population per year. This figure was higher for women (614) than for men (416). If we consider the age-specific incidence of strokes, it becomes obvious that only at the age of 80 years and older is it higher in women; in other age groups, the incidence of acute cerebrovascular accidents (ACVA) is higher in men.

Mortality due to strokes amounted to 222 per 100 thousand population per year. In women it is almost twice as high, but again due to the oldest age group. Among men 50-79 years old, the mortality rate is higher: for example, in the group 60-69 years old, this figure for males is 3.5 times higher.

Mortality for ischemic stroke was 39%, for hemorrhagic stroke - 71%.

More than a quarter of patients with stroke (28.9%) had a recurrent stroke: 85.00% of them had a history of one previous stroke, 12.50% had two, 1.25% had three, and 1.25% had four.

Of significant importance both for prevention and for the organization of medical care are data on the most typical time and place of stroke onset.

The vast majority of cases of hemorrhagic strokes occur in the winter months - 41%, and ischemic strokes - in January, March and May. The most vulnerable days of the week were Monday, Tuesday and Friday, the calmest were Sunday and Thursday. Ischemic stroke most often began in the first half of the day - up to 76% of cases. The onset of hemorrhagic stroke was most often noted from 12.00 to 18.00 (56%).

The place of onset of ischemic stroke was most often the patient’s home (77% of cases), hemorrhagic stroke - the street, home (34% each), and work (28%).

One of the main aspects of our research is also the study risk factors.

In Fig. Figure 1 shows the percentage expression of various factors for ischemic and hemorrhagic strokes. In table Table 1 shows the absolute and relative risk of strokes depending on the presence of certain factors, the significance of which is indicated in Table. 2.

Fig. 1 Risk factors for strokes

Stroke Center

New “Answers to Questions”

Why do you take patients from a difficult situation (for example, untidy ones, with a tracheostomy, with a gastrostomy, bedridden and hopeless ones, which require a lot of scrutiny)?

Thus, we accept patients for treatment in any case and with any concomitant illnesses, in addition to contagious infections. We have a whole staff of qualified nurses and consultants (anesthesiologist, cardiologist, urologist, endocrinologist, psychiatrist, etc.) that we can provide Read more »

Hello! Tell me, my father had a stroke and is still in serious condition, but I would like to understand whether he will need rehabilitation after, or is there a chance that everything will be okay?

Good day! Rehabilitation will be required for all patients who, as a result of damage to the nervous system (for example, stroke or head injury), have significant impairments in function that interfere with life. Simpler than it seems, Read more »

Good afternoon My dad suffered a stroke two weeks ago (speech and the right side of his body were impaired). Two years ago he received 3 stents. Tell me, is it possible to do an MRI or CT scan in this case? Thank you!

Hello, Ekaterina.

As far as I know, stents do not interfere with CT scans. As for MRI, it depends on the material the stent is made of.

Stroke is the second most common killer of people worldwide. In modern Russia, among the causes of mortality, cerebral stroke is in second place after myocardial infarction. Every year, 450,000 people suffer a stroke, the actual population big city. Mortality rates in Russia are 4 times higher than in the USA and Canada. Among European countries, the mortality rate from cerebrovascular diseases in Russia is the highest. According to the All-Russian Center for Preventive Medicine, in our country 25% of men and 39% of women die from cerebrovascular diseases.

The incidence of stroke ranges from 460 to 560 cases per 100,000 population. In the largest cities of the country, the situation with this type of pathology is extremely unfavorable. In St. Petersburg, for example, the incidence of stroke in 2008 was 528 cases per 100,000 population, while the mortality rate for ischemic stroke in the same year was 39%. In Moscow, the number of patients with stroke for a long time (almost 20 years) has not decreased below 36,000 patients annually. It should be emphasized the catastrophic consequences of ischemic stroke - up to 84-87% of patients die or remain disabled and only 16-13% of patients fully recover. But even among surviving patients, 50% have a second stroke in the next 5 years of life.

Among all strokes, 80% are ischemic strokes. Moreover, 95% of ischemic strokes and transient ischemic attacks (TIA) are associated with complications of an embolic nature from plaques localized in the extracranial parts of the arterial system. It should also be emphasized that only 15% of patients who suffered a stroke had a history of clear indications of the presence of neurological symptoms in the form of TIA. In recent years, the frequency of ischemic strokes has become 2-3 times higher than the number of myocardial infarctions.

Stroke is a major health problem among adults and is the third leading cause of death in developed countries. 31% of stroke patients require assistance for personal care, and 20% are unable to walk independently. Only about 20% of patients can return to their previous work. Stroke imposes special obligations on family members of the patient and places a heavy socio-economic burden on society. In St. Petersburg, 12 thousand cases of stroke are registered annually, with every fourth patient under 65 years of age. These figures are higher than the Russian average.

Acute ischemic stroke is one of the most common causes of death and disability worldwide. In Russia this problem is especially acute. Mortality from stroke is 175 cases per 100,000 population per year.
According to the National Stroke Association (NASA), 31% of stroke patients require special care, 20% cannot walk independently and only 8% can return to their previous full life.
In St. Petersburg, approximately 25 thousand people suffer a stroke every year. Mostly these are elderly people, although in lately This disease is increasingly common among young people. The incidence of strokes and mortality from them in St. Petersburg is much higher than in economically developed countries and in Russia as a whole, but a successful outcome is much less common.