Clinical presentation patterns and neurological status among stroke subtypes

M. Mizanur Rahman; M. Habibur Rahman; Safikul Islam; Mohammad Aminul Islam; M. Khairuzzaman; Nisat Zabin; M. Kawser Hamid

doi:10.18203/2349-3933.ijam20253351

Authors

M. Mizanur Rahman Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
M. Habibur Rahman Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh
Safikul Islam National Gastroliver Institute and Hospital, Dhaka, Bangladesh
Mohammad Aminul Islam Department of, Medicine, Shahid M. Monsur Ali Medical College, Shirajgong, Bangladesh
M. Khairuzzaman Department of Cardiology, Dhaka Medical College Hospital, Bangladesh
Nisat Zabin Central Police Hospital, Rajarbag, Dhaka, Bangladesh
M. Kawser Hamid 250-bedded General Hospital, Jhenaidah, Bangladesh

DOI:

https://doi.org/10.18203/2349-3933.ijam20253351

Keywords:

Stroke subtypes, Clinical presentations, Neurological severity, Glasgow coma scale, Bangladesh

Abstract

Background: Differentiating stroke subtypes through distinct clinical presentation and neurological severity is essential for prompt management, especially in resource-constrained settings. This study aimed to compare clinical presentation patterns and neurological status among ischemic and hemorrhagic stroke patients in Bangladesh.

Methods: A cross-sectional observational study was conducted among 100 adult stroke patients admitted to a tertiary hospital. Clinical features and neurological severity (Glasgow coma scale, GCS) were assessed and compared by stroke subtype. Predictors of impaired consciousness were identified using Cox regression analysis.

Results: Among participants, ischemic stroke (74%) predominated over hemorrhagic stroke (26%). Hemorrhagic stroke was significantly associated with impaired consciousness (80.76% versus 59.45%; p=0.023), headache (80.76% versus 45.94%; p=0.004), vomiting (73.07% versus 41.89%; p=0.019), neck rigidity (80.76% versus 6.75%; p<0.001), hiccups (46.15% versus 22.97%; p=0.041), and convulsions (30.76% versus 12.16%; p=0.041). Unconsciousness (GCS≤8) was notably higher in hemorrhagic stroke (38.5% versus 20.3%; p=0.041). Cox regression identified hemorrhagic stroke (HR 2.85, p=0.006), neck rigidity (HR 3.41, p=0.003), convulsions (HR 2.12, p=0.047), age >55 years (HR 1.26, p=0.01), and BMI >30 (HR 1.08, p=0.03) as independent predictors of impaired consciousness.

Conclusion: Significant subtype-specific clinical presentations and neurological impairment were observed, with hemorrhagic stroke associated with greater severity. Enhanced clinical awareness and targeted management strategies are essential in improving acute stroke care outcomes in Bangladesh.

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References

Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89. DOI: https://doi.org/10.1161/STR.0b013e318296aeca

Abbott AL, Silvestrini M, Topakian R, Golledge J, Brunser AM, de Borst GJ, et al. Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice. Front Neurol. 2017;8:537. DOI: https://doi.org/10.3389/fneur.2017.00537

Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(2):132-44. DOI: https://doi.org/10.1177/17474930241308142

Feigin VL, Owolabi MO, Abd-Allah F, Akinyemi RO, Bhattacharjee NV, Brainin M, et al. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission. Lancet Neurol. 2023;22(12):1160-206. DOI: https://doi.org/10.1016/S1474-4422(23)00277-6

Mondal MBA, Hasan ATMH, Khan N, Mohammad QD. Prevalence and risk factors of stroke in Bangladesh: A nationwide population-based survey. eNeurol Sci. 2022;28:100414. DOI: https://doi.org/10.1016/j.ensci.2022.100414

Shuvo TA, Hosna AU, Hossain K, Hossain S. Prevalence of stroke in Bangladesh: A systematic review and meta-analysis. J Stroke Cerebrovas Dis. 2024;108017. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108017

Aziz M, Bipasha N, Gupta U, Ramnarine IV, Redgrave J, Ali AN, et al. Stroke in Bangladesh: A Narrative Review of Epidemiology, Risk Factors and Acute Stroke Services. J Cardiovas Development Dis. 2025;12(2):58. DOI: https://doi.org/10.3390/jcdd12020058

Bhowmik NB, Abbas A, Saifuddin M, Islam MR, Habib R, Rahman A, et al. Ischemic Strokes: Observations from a Hospital Based Stroke Registry in Bangladesh. Stroke Res Treat. 2016;2016:5610797. DOI: https://doi.org/10.1155/2016/5610797

Fekadu G, Chelkeba L, Melaku T, Tegene E, Kebede A. 30-day and 60-day rates and predictors of mortality among adult stroke patients: Prospective cohort study. Annals of Med Surg. 2020;53:1-11. DOI: https://doi.org/10.1016/j.amsu.2020.03.001

Pulvers JN, Watson JD. If time is brain where is the improvement in prehospital time after stroke? Front Neurol. 2017;8:617. DOI: https://doi.org/10.3389/fneur.2017.00617

Deng H, Wang X, Yin L, Li X, Zhang Y. Prevalence and determinants of prehospital delay among stroke patients in mainland China: A systematic review and meta-analysis of the study protocol. PLoS One. 2024;19(10):e0312551. DOI: https://doi.org/10.1371/journal.pone.0312551

Yang N, Hartanto YB. Characteristics and reasons for delayed presentation in acute ischemic stroke: single-centered study in Indonesia. Egypt J Neurol Psy Neurosurg. 2024;60(1):67. DOI: https://doi.org/10.1186/s41983-024-00838-4

Ali M, van Os HJ, van der Weerd N, Schoones JW, Heymans MW, Kruyt ND, et al. Sex differences in presentation of stroke: a systematic review and meta-analysis. Stroke. 2022;53(2):345-54. DOI: https://doi.org/10.1161/STROKEAHA.120.034040

Padwale V, Chivate C, Kirnake V, Patil H, Kumar S, Pantbalekundri N. Comparative Prognostic Value of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) in Supratentorial and Infratentorial Stroke Patients in Western India. Cureus. 2024;16(7):e65778. DOI: https://doi.org/10.7759/cureus.65778

Miah MT, Hoque AA, Khan RR, Nur Z, Mahbub MS, Rony RI, et al. The Glasgow Coma Scale following acute stroke and in-hospital outcome: An observational study. J Med. 2009;11-4. DOI: https://doi.org/10.3329/jom.v10i3.2009

Ojha PT, Basak S, Aglave V, Yadav J. Incidence of stroke in adults according to age, sex and subtypes in urban Indian population. Neurol Neurosci Rep. 2020;3(1). DOI: https://doi.org/10.15761/NNR.1000117

Abdu H, Tadese F, Seyoum G. Comparison of Ischemic and Hemorrhagic Stroke in the Medical Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study. Neur Res Int. 2021;2021:9996958. DOI: https://doi.org/10.1155/2021/9996958

Ahangar AA, Saadat P, Heidari B, Taheri ST, Alijanpour S. Sex difference in types and distribution of risk factors in ischemic and hemorrhagic stroke. Int J Stroke. 2018;13(1):83-6. DOI: https://doi.org/10.1177/1747493017724626

Bamekhlah RM, Bamekhlah MR, Al-Ghazali HS, Bahishwan AA. Comparative Study between Haemorrhagic and Ischaemic Strokes in Hadramout: A Hospital-based Study. Hamdan Med J. 2019;12(1):29-33. DOI: https://doi.org/10.4103/HMJ.HMJ_62_18

Vincent M, Sereke SG, Nassanga R, Robert M, Ameda F. Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study. Health Sci Rep. 2023;6(5):e1248. DOI: https://doi.org/10.1002/hsr2.1248

Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. J Commun Disord. 2013;46(3):238-48. DOI: https://doi.org/10.1016/j.jcomdis.2013.04.001

Song W, Wu M, Wang H, Pang R, Zhu L. Prevalence, risk factors, and outcomes of dysphagia after stroke: a systematic review and meta-analysis. Front Neurol. 2024;15:1403610. DOI: https://doi.org/10.3389/fneur.2024.1403610

Wen X, Fan B, Zhan J, Wen H, Ban H, Yang Y, et al. Integrated analysis of the prevalence and influencing factors of poststroke dysphagia. Eur J Med Res. 2025;30(1):27. DOI: https://doi.org/10.1186/s40001-024-02263-y

Admas M, Teshome M, Petrucka P, Telayneh AT, Alamirew NM. In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. SAGE Open Med. 2022;10:20503121221122465. DOI: https://doi.org/10.1177/20503121221122465

Derex L, Rheims S, Peter-Derex L. Seizures and epilepsy after intracerebral hemorrhage: an update. J Neurol. 2021;268(7):2605-15. DOI: https://doi.org/10.1007/s00415-021-10439-3

Shigematsu K, Shimamura O, Nakano H, Watanabe Y, Sekimoto T, Shimizu K, et al. Vomiting should be a prompt predictor of stroke outcome. Emerg Med J. 2013;30(9):728-31. DOI: https://doi.org/10.1136/emermed-2012-201586

Giri S, Tronvik E, Dalen H, Ellekjær H, Olsen A, Hagen K. Headache disorders and risk of stroke: A register-linked HUNT study. Cephalalgia Rep. 2024;7:25158163241295735. DOI: https://doi.org/10.1177/25158163241295735

Banerjee TK. Neuroepidemiology of stroke in low and middle income countries. Front Neurol. 2022;13:1059974. DOI: https://doi.org/10.3389/fneur.2022.1059974