RISK FACTOR PROFILE AND ETIOLOGIC CLASSIFICATION (TOAST CLASSIFICATION) OF ISCHEMIC STROKE FROM A TERTIARY CARE CENTER FROM NORTHERN INDIA

Introduction: Stroke is an etiologically heterogeneous disease, identifying specific cause in every patient is important because management and long-term strategies to prevent recurrences differ considerably. The TOAST classification has been found to be useful for early stroke classification and planning management, but such studies are sparse in northern india. Aims And Objective : To determine etiologic classification of ischemic stroke patients based on TOAST criteria in northern india and study risk factor profile of our stroke patients. Material And Methods: Our study was an observational, prospective cohort study, conducted in university hospital in Srinagar Kashmir india. Patients with Ischemic stroke (according to the World Health Organization criteria)1 or transient ischemic attack (TIA)1 were included in study. Information on demography (age, gender), vascular risk factors were collected on admission. Etiological workup included routine blood investigations, brain computed tomography/magnetic resonance imaging, carotid and vertebral doppler and echocardiograghic examination. Results: In our study 800 patients with ischemic stroke were included, 54% (432) were males and 46% (368) were females (Table 1). The peak age of incidence was 61-70 years; with 19.5% of cases in males and 18.5% of cases in female in this age bracket. On classification of patients as per TOAST criteria we found that 160 (20%) of patients had atherothrombotic , 312 (39%) had cardioembolic, 176 (22%) had lacunar and 152 (19%) had stroke of undetermined etiology. Hypertension (59.4%) was the most common risk factor, followed by smoking (52.6%), diabetes (30.1%), obesity (26.3%) and history of stroke (10.5%). Conclusion: This study gives a good insight into etiological classification and risk factor profile of stroke patients in north india. The etiological classification helps in the immediate treatment decision making; and risk factor profile helps in long term strategies like secondary prevention of stroke. In our study Hypertension and smoking were the two most important risk factors in stroke patient whereas cardioembolic stroke was the most common type of stroke according to TOASTcriteria.