1 / 25

Clinical correlation of Vitamin D Deficiency and Stroke Subtypes: According to TOAST criteria

Clinical correlation of Vitamin D Deficiency and Stroke Subtypes: According to TOAST criteria. Varuna Nargunan, PGY 3 Mentors: Peterkin Lee-Kwen, MD Michael Merrill, MD. Objective. Prevalence of Vitamin D deficiency in patient diagnosed with stroke at South Buffalo Mercy Hospital

jayme-bowen
Télécharger la présentation

Clinical correlation of Vitamin D Deficiency and Stroke Subtypes: According to TOAST criteria

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Clinical correlation of Vitamin D Deficiency and Stroke Subtypes: According to TOAST criteria Varuna Nargunan, PGY 3 Mentors: Peterkin Lee-Kwen, MD Michael Merrill, MD

  2. Objective • Prevalence of Vitamin D deficiency in patient diagnosed with stroke at South Buffalo Mercy Hospital • Classification of ischemic strokes subtypes according to TOAST criteria • Clinical correlation of Vitamin D deficiency with • Ischemic stroke subtypes (TOAST criteria), • Stroke severity (NIHSS) • Disability due to Stroke (Modified Rankin Score)

  3. Vitamin D Physiology

  4. Vitamin D Physiology

  5. Incidence of Vitamin D Deficiency

  6. Clinical significance of Vitamin D • Mortality decrease by 7% with vitamin D replacement • Bone – Decrease incidence of osteoporosis, 43% decrease of hip fracture and 58% reduction of non vertebral fracture • Muscle - >30% decrease in grip strength is related to Vitamin D deficiency • More than >50% of multiple sclerosis associated with low vitamin D • CAD & CVD – increase Hypertension, Diabetes mellitus, dyslipidemia (accelerated rate of atherosclerosis)

  7. Vitamin D and Vascular disease • 34 out of 44 patients with acute stroke had low vitamin D within 30 days statistically significant. Stroke. 2006;37:243-45 • LURIC study – 3316 patients, 42 fatal(27 ischemic, 8 hemorrhagic, 7 of unknown) strokes. Low vitamin D are independently predictive for fatal strokes Stroke. 2008;39:2611-2613 • Deficiency and post stroke hemiplegia – Significant bone mass reduction in hemiplegic side related to Vitamin D deficency – statistically significant. Stroke a journal of cerebral circulation. 1996; Volume 27(12): 2183-2187

  8. Vitamin D and Vascular Disease • 120 patients with 1st cardiovascular event were found to have low vitamin D level after adjusting other risk factors Circulation. 2008; 117 • Case series: 4 out of 5 wheelchair bound patients had complete resolution of the muscle ache and pain, fully mobile: Arch intern Med. 2000;160:1199-1203 • Large prospective study yet to be done

  9. Clinical Significance of TOAST Criteria • Widely used to classify ischemic stroke subtypes • It is used to determine • the prognosis • long term survival • risk of recurrence • treatment options

  10. Toast Subtypes • Large Artery Atherosclerosis (LAA) • CardioEmbolism (CE) • Small Artery Occlusion (SAO) • Stroke of other determined causes (OC) • Stroke of undetermined cause (UND)

  11. Modified Rankin Score 0 No symptoms at all • No significant disability despite symptoms; able to carry out all usual duties and activities 2 Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance

  12. Modified Rankin Score • Moderate disability; requiring some help, but able to walk without assistance • Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance • Severe disability; bedridden, incontinent and requiring constant nursing care and attention 6 Dead

  13. Study Method • Retrospective chart review of patients with stroke presented to Mercy Hospital between Jan 2008 to Mar 2009 • 225 charts with stroke diagnosis were reviewed • 62 patients met study inclusion criteria

  14. Inclusion criteria Age >20 years Diagnosis of Ischemic stroke, confirmed by CT or MRI 25 hydroxy Vitamin D level measured within 30 days of stroke Exclusion criteria 25 hydroxy Vitamin D measured more than 30 days after stroke Study Method contd.

  15. Data Collected • Demographic information • History of • Hypertension • Diabetes mellitus • Dyslipidemia • Atrial fibrillation • CAD • CHF • Smoking • Osteoporosis • Family history of stroke • Vitamin D supplements

  16. Data Collected • 25 hydroxy Vitamin D • Fasting Lipid profile • 2D Echo/TEE • Carotid doppler/CTA/MRA • CT or MRI of the brain

  17. Results • Prevalence of Vitamin D deficiency (<30 nmol/l) = 45/62 (=70%) • Compared Vit D levels to TOAST sub types, MRS values and NIH Stroke Scale for Correlation and Regression analysis.

  18. Regression Analysis Vit D vs NIH Stroke Scale (NIHSS) Pearson Correlation = 0.07

  19. Regression Analysis Vit D Vs Modified Rankin Score (MRS) Pearson Correlation = 0.02

  20. Regression AnalysisVit D vs TOAST type Pearson Correlation = 0.17

  21. Prevalence of Vitamin D deficiency for TOAST Subtypes

  22. Prevalence of Vitamin D deficiency for MRS values

  23. Prevalence of Vit D deficiency for NIHSS values

  24. Conclusions • Vitamin D deficiency is unrecognized • High incidence in Western NY • Very high incidence in Stroke(70%) • No correlation with stroke subtype • Probably associated with increased association with LAA and CE • Easily treatable condition

  25. Thank you

More Related