07.dr rajeev kumar ranjan.cdr INTRODUCTION Stroke has been conventionally dened as a neurological decit of focal nature persisting for more than 24 hours due to stoppage of cerebral blood supply. This dening timeline boundary is also useful in distinguishing Transient Ischemic attack (TIA) which is not of more than 24 hours duration but can mimic stroke clinically. (1) The problem of Stroke is ram pant worldwide but in resource limited settings particularly in third world and developing countries like India it's a major problem as it not only causes morbidity but due to lack of dedicated care also produces mortality and complications compounding the problem.(2,3) Advances in care in the course of recent years have extraordinarily improved the result for stroke patients with a decrease in mortality and more patients at last accomplishing autonomy. Among a few potential changes, three components are to a great extent liable for this improvement. First was the development of devoted stroke units that offer both intense and rehabilitative consideration for the different and variable needs of stroke patients. Second was the presentation of intravenous thrombolysis, which addressed the principal compelling treatment for intense ischemic stroke. And lastly third which is by no means is the least, is general awareness in the public about the gravity of the situation. (4,5) Various governments are more proactive now as they are now with dedicated programmes to increase the awareness , generate the evidence about the prevalence , and improved surveillance like UK's ACT FAST campaign programme , and in India NPCDCS (6,7) . Despite the advances even in developed countries and in India many patients don't fully recover from Stroke and remain crippled for many years resulting in huge economic losses. This scenario has been well generalized as the rule of one third which says one third dies after stroke , one third remains long term disabled while rest of the third recover fully to have their dependency removed .( 8,9) Most of strokes are Ischemic (around 80%) and the greater part of these identify with issues with blood vessel blood stream to the cerebrum; ischemic stroke auxiliary to venous inadequacy is substantially less normal. Hemorrhagic stroke represents the rest 20% . (10, 11) With modern changes and new innovations in technology now a days imaging is an integral part for any case of stroke coming to the emergency of any multi or Superspeciality facility. (12, 13) An early imaging in stroke patients not only helps in excluding hemorrhages in the intracranial area, marking out the ischemia, and ruling out any mimickers. It also helps in better visualization of the intracranial and extracranial vasculature and helps in understanding the status of cerebral perfusion. The imaging also marks out clearly the infarct core and the penumbra which aids in further management of the stroke patients . (13,14) Computed Tomography (CT) scanning is the gold standard when it comes to choosing for the imaging modality in patients coming in emergency department with stroke presenting as some neurologic decit or other associated features. CT scans owing to certain advantages over other modalities have been the mainstay as they are more reliable in showing the difference between cerebral hemorrhage and infarction as well as its relative availability. (12, 13) Owing to these advantages and ease of availability or vice versa CT has remarkably changed the way patients with COMPUTED TOMOGRAPHY (CT) SCAN EVALUATION OF STROKE PATIENTS IN RADIODIAGNOSIS DEPARTMENT OF RIMS, RANCHI Original Research Paper Dr. Rajeev Kumar Ranjan Associate Professor, Department Of Radiodiagnosis, RIMS, Ranchi, Jharkhand X 17GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Radiodiagnosis INTRODUCTION: Advances in care in the course of recent years have extraordinarily improved the result for stroke patients with a decrease in mortality and more patients at last accomplishing autonomy. Computerized Tomographic (CT) scanning is the gold standard when it comes to choosing for the imaging modality in patients coming in emergency department with stroke presenting with some neurologic decit or other associated features. METHODOLOGY: A cross sectional study of the available CT records for patients coming with stroke in RIMS Ranchi was evaluated from Feb 2018-Aug 2018 after seeking appropriate clearance. Data thus collected were analyzed using SPSS version 16 using standard statistical methods like mean, standard deviation, chi square test of signicance etc. P values of <.05 were considered to be of statistical signicance. RESULTS: A total 275 patients were included in the evaluation . In this study we found that the average age for male particiapnts were 55.75 ±7.99 while females were having a mean age 53.07 ± 11.85 . 25% of the patients with Stroke were not diagnosed as hypertension cases while most patients recorded a GCS in mild category (44% ), while more stroke incidents were infarct in nature ( 51%) followed by hemorrahgic incidenes (21%) . Cerebrovascular accidents were right side (51%) on location while mixed location ndings were (21% ). CONCLUSION: Our investigation shows that Ischemic stroke is comoner than hemorrhagic in patients and greater part happened in the older patients. Computer Tomography (CT ) is an exceptionally valuable instrument in making the analysis of stroke just as separating hemorrrhage from ischemia which is useful in treatment of stroke patients. ABSTRACT KEYWORDS : VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Paras Nath Ram* Associate Professor, Department Of Radiodiagnosis, RIMS, Ranchi, Jharkhand *Corresponding Author Dr. Suresh Kumar Toppo Professor & Head, Department Of Radiodiagnosis, RIMS, Ranchi Dr. Pulak Abhishek Senior Resident, Department Of Radiodiagnosis, RIMS,Ranchi 18 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Stroke are now managed with reduced mortality and morbidity owing to prompt diagnosis, better guided interventions and follow up . This study is done with an aim to understand the incidence of stroke in patients coming in the Department of Radio diagnosis for CT scan. The study intends to nd out the nature of stroke, its occurrence in various age groups, different genders and various types of hemorrhages or infarcts coming up in the hospital . Data regarding these are almost non existent for Jharkhand , in Ranchi and neighboring districts . This study will give an insight and will aid further research in this area . MATERIALS & METHODS A cross sectional study was undertaken after clearance from the appropriate authorities. The study consists of data collected from 275 patients undergoing CT scan in the Department of Radiodiagnosis RIMS, Ranchi who presented with clinical features of stroke. Study was done from Feb 2018 to Aug 2018. Questionaire to collect the data was designed in the Radio Diagnosis Department of RIMS, Ranchi. Patients with history of head injury were excluded from the study. CT scan of patients were done on Siemens Somatom Sensation 16 slices CT scan machine. Records of patients undergoing CT scan for Stroke as primary diagnosis was reviewed in the department. We looked for Age, Gender, and Address, and Above Poverty Line/Below Poverty Line, HTN diagnosed or not, Stroke features, GCS and CT ndings. Incomplete entries (if any) and follow up cases, were excluded from our record review. Statistical analysis was done after having the data on MS Ofce , Microsoft excel sheets on SPSS version 16.0 . Measures of central tendency , mean standard deviation and percentages were used to describe the results . While tests of association like Chi square were used to determine the relationship between various ndings. P value of <.05 was considered to be statistically signicant. RESULTS A total 275 records were included in the evaluation . In our record analysis we found that the average age for male particiapnts were 55.75 with a standard deviation of 7.99 while females were having a mean age 53.07 with a standard deviation of 11.85. We had as per the records 136 males while 139 females . None of the Males were less than 18 years while females were in the age group of 12-70 . We futher had a breakdown of various religion , SES , Locality and Employment status of the records of CT avaialble in the department (Table 1, 2) . Study showed that most of the patients seen were Hindu(58.2%) followed by Sarna ( 16.4%) and Sikh(14.5%). (Table 1) . We had more BPL patients but APL patients too were present for CT scanning of their episodes of Stroke or neurological decit which was close to 40% ( Table 2) . The majority of pateints wth stroke were in the age group of 45-65 (72%) while for males and females the break up was 76.5% and 67.6% respectively . Age category and sex were associated with statitical signicance . (Table 2) . We also evaluated the CT scan records for various features like Location of the injury , type of cerebrovascular compromise , whether Hypertension was prediagnosed or not and Glassgow coma scale scores at the time of admission mentioned . GCS was graded in three categories Mild degree of confusion with scores of 13-15 , while moderate for scores of 9-12 and severe for scores of 3-8 . We found that 25% of the patients with Stroke were not diagnosed as HTN cases while most patients recorded a GCS in mild category 44% , while more stroke incidents were infarct in nature ( 51%) followed by hemorrahgic incidenes (21%) . Most of the cerebrovascular incidents were right side (51%) on location while mixed location ndings were 21% . (Table 3) VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Table 1 : Socieconomic Distribution of Records review according to Religion and Gender Gender Male =136, Females 139 Religion Total Hindu Muslim Sikh Sarna Total Age Categorization 12-30 n 2 3 1 1 7 % 28.6% 42.9% 14.3% 14.3% 100.0% 30-45 n 23 0 6 2 31 % 74.2% 0% 19.4% 6.5% 100.0% 45-65 n 114 19 29 36 198 % 57.6% 9.6% 14.6% 18.2% 100.0% 65-70 n 21 8 4 6 39 % 53.8% 20.5% 10.3% 15.4% 100.0% Total n 160 30 40 45 275 % 58.2% 10.9% 14.5% 16.4% 100.0% P value<.05 Figure 1: Left Hemispheric Intracerebral hemorrhage in one of the Patients Figure 2: Right MCA territory infarct in one of the Patients Table 2 : Gender Wise distribution of SES, Residence and Employment Status of Records Gender SES Residence Employment Total APL BPL Urban Rural Employed Non Employed Male Age Categorization 30-45 n 7 5 1 11 12 0 12 % 58.3% 41.7% 8.3% 91.7% 100.0% 0.0% 100.0% 45-65 n 45 59 47 57 55 49 104 % 43.3% 56.7% 45.2% 54.8% 52.9% 47.1% 100.0% 65-70 n 3 17 2 18 8 12 20 X 19GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra % 15.0% 85.0% 10.0% 90.0% 40.0% 60.0% 100.0% Total n 55 81 50 86 75 61 136 % 40.4% 59.6% 36.8% 63.2% 55.1% 44.9% 100.0% Female Age Categorization 12-30 n 3 4 2 5 1 6 7 % 42.9% 57.1% 28.6% 71.4% 14.3% 85.7% 100.0% 30-45 n 3 16 8 11 6 13 19 % 15.8% 84.2% 42.1% 57.9% 31.6% 68.4% 100.0% 45-65 n 40 54 40 54 10 84 94 % 42.6% 57.4% 42.6% 57.4% 10.6% 89.4% 100.0% 65-70 n 5 14 12 7 5 14 19 % 26.3% 73.7% 63.2% 36.8% 26.3% 73.7% 100.0% Total n 51 88 62 77 22 117 139 % 36.7% 63.3% 44.6% 55.4% 15.8% 84.2% 100.0% DISCUSSION As the population increases along with a life style which is conducive to developing the NCDs the number of Stroke patients will increase thus mandating rapid evaluation of such patients . As of now non contrast CT is the primary imaging modality being employed routinely for all stroke cases . CT is all the more normally used owing to its across the board accessibility, reasonableness for the unwell and therapeutically temperamental pat ient and precis ion in barr ing contraindications to intravenous thrombolysis. What's more, when evaluated by competent people, non-contrast CT gives complimentary data on the nearness of early infarct and, now and again, gives a particular proportion of blood vessel rupture when a hyperdense course is recognized. (15,16) In our study we saw majority of patients were in the age group of 45-60 (72%) . This nding is in accordance to other studies conducted in similar settings . (12,13,17) We found an association of males and their employment status to be of staisitcal signicance which is similar to ndings from other studies as well (11,12) . The location of the cerebrovascular accident in form of infarcts were almost similar to other studies across different study settings ( 8,9,12) The relationship of hypertension and its consequences as stroke is well known but as the rule of halves suggest for HTN in our study too we saw almost 25% of Stroke patients not being diagnosed with Hypertension . This ndings has been well illustrated in other studies as well ( 8,10,12,13) CONCLUSION As its record based review with small smaple size more research needs to be done for tangible evidence to suggest and address various aspects of the Stroke incident in patients. In our study infarcts were more common occurrence as has been the trend world wide. Timely CT is an integral component in management of Stroke Patients so that they can recover and morbidity can be lowered. REFERENCES 1. Mathers CD, Bernand C, Iburg KM, Inoue M, Ma Fat D, Shibuya K, et al. Global burden of disease: data sources, methods and results. 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Stroke. 1997;28(3):491-499. Table 3 : Description of The CT ndings and its relationship with HTN Diagnosis Occurrence Location Glasgow Coma Scale Total Ischaemic Hemorrhagic Mixed Right Left Bilateral Mild (13-15) Moderate (9-12) Severe (3-8) HTN Diagnosed Y N 111 51 45 121 56 30 102 60 45 207(75%) % 53.6 24.6 21.7 58.5 27.1 14.5 49.3 29.0 21.7 100.0 N N 31 24 13 33 10 25 21 37 10 68(25%) % 45.6 35.3 19.1 48.5 14.7 36.8 30.9 54.4 14.7 100.0 Total N 142 75 58 154 66 55 123 97 55 275(100%) % % 51.6 27.3 21.1 56.0 24.0 20.0 44.7 35.3 20.0 100.0 p value >.05 p value <.005 p value <.005