Characterization of Stroke Signs and Symptoms: Findings from the Atherosclerosis Risk in Communities Study
Background: Although patterns of stroke occurrence and mortality have been well studied, little epidemiologic data are available regarding the clinical characteristics of stroke events. Methods: We evaluated hospitalized stroke events reported in the Atherosclerosis Risk in Communities Study to describe the clinical characteristics of incident stroke. Incident confirmed stroke cases (n=474) were evaluated for stroke symptoms including headache, vertigo, gait disturbance, and convulsions. Cases were also evaluated for stroke signs including hemianopia, diplopia, speech deficits, paresis, and parasthesia/sensory deficits. Stroke characteristics were also evaluated for univariate associations with race, gender, and stroke subtype. Results: Over an average follow-up of 9.2 years, 407 (86%) ischemic and 67 (14%) hemorrhagic strokes occurred. Stroke symptoms in order of decreasing frequency (95% confidence intervals) were headache (27.4%, 23.4%-31.4%), gait disturbance (10.8%, 7.9%-13.6%), convulsions (4.4%, 2.6%-6.3%), and vertigo (2.1%, 0.8%-3.4%). Speech deficits occurred in 64.1% (59.8%-68.5%), hemianopia in 14.6% (11.4%-17.7%), and diplopia in 5.5% (3.4%-7.5%) of cases. Most cases involved paresis (81.6%, 78.1%-85.1%), predominantly of the arms (75.5%, 71.6%-79.4%). Fewer subjects experienced sensory deficits (44.5%, 40.0%-49.6%), predominantly in the arms (38.6%, 34.2%-43.0%). Blacks were more likely than whites to experience paresis (85.8% vs 77.9%, p=0.03). Men were more likely than women to experience a gait disturbance (14.3% vs 6.7%, p=0.001). As expected, persons with hemorrhagic strokes had a higher proportion of headaches (59.7% vs 22.1%, p=0.001) and convulsions (11.9% vs 3.2%, p=0.001) than those with ischemic events, while speech deficits were more common in ischemic strokes (68.1% vs 40.3%, p=0.001). Conclusions: We present epidemiologic data concerning the clinical characteristics of incident stroke in a population-based cohort. While minor differences by race, gender, and stroke subtype were observed, data from additional follow-up is required to confirm observed variation.