Cerebrovascular Disease Natural History

Approximately one-third of all 'strokes' are fatal. The age of the patient, the anatomical size of the lesion, the degree of deficit and the underlying cause all influence the outcome.

Immediate outcome

In cerebral haemorrhage, mortality approaches 70%.

Cerebral infarction fares better, with an immediate mortality of less than 25%, fatal lesions being large with associated oedema and brain shift.

Embolic infarction carries a better outcome than thrombotic infarction. Fatal cases of infarction die either at onset or else, more commonly, after the first week from cardiovascular or respiratory complications.

The level of consciousness on admission to hospital gives a good indication to immediate outcome. The deeper the conscious level the graver the prognosis.

Long-term outcome

The prognosis following infarction due to thrombosis or embolisation from diseased neck vessels or heart is dependent on the progression of the underlying atherosclerotic disease. Recurrent cerebral infarction rates vary between 5%-15% per year. Symptoms of coronary artery disease and/or peripheral vascular disease may also ensue. Five year mortality is 44% for males and 36% for females.

The long-term prognosis following survival from haemorrhage depends upon the cause and the treatment.

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