Published Online
on August 7, 2003

A more recent version of this article appeared on September 1, 2003

This Article Full Text (PDF) All Versions of this Article: 34/9/2103    most recent 01.STR.0000088063.74250.DBv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saposnik, G. Articles by for the Iberoamerican Society of Cerebrovascular Diseases Search for Related Content PubMed PubMed Citation Articles by Saposnik, G. Articles by for the Iberoamerican Society of Cerebrovascular Diseases, Related Collections Cerebrovascular disease/stroke Acute Stroke Syndromes Cerebral Lacunes Embolic stroke Risk Factors for Stroke Epidemiology

Submitted on May 28, 2003
Accepted on May 30, 2003

Stroke in South America. A Systematic Review of Incidence, Prevalence, and Stroke Subtypes

Gustavo Saposnik MD^*; Oscar H. Del Brutto MD; and for the Iberoamerican Society of Cerebrovascular Diseases

From the Stroke Unit, Department of Neurology, Ramos Mejia Hospital, Buenos Aires University, Argentina (G.S.), and Stroke Unit, Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador (O.H. Del B.).

^* To whom correspondence should be addressed. E-mail: gsaposnik{at}intramed.net.ar.

Background and Purpose--Stroke is a leading cause of mortality and disability in South America because of an increase in life expectancy and changes in the lifestyle of the population. Because epidemiological and clinical characteristics of stroke vary according to regional factors, we need to know the peculiarities of stroke on this continent.

Methods--We performed a systematic review of articles on stroke in South America, with emphasis on those providing information on the incidence and prevalence of stroke (community-based studies) and the pattern of stroke subtypes (hospital-based studies).

Results--Seven papers provided information on stroke epidemiology; 11 gave data on the pattern of stroke subtypes. Community-based studies showed crude stroke prevalence rates ranging from 1.74 to 6.51 per 1000 and annual incidence rates from 0.35 to 1.83 per 1000. Hospital-based stroke registries consistently reported a high frequency of intracranial hemorrhages, which accounted for 26% to 46% of all strokes. Among patients with cerebral infarctions, intracranial atherosclerotic lesions and small-vessel disease have been common pathogenic mechanisms underlying the stroke. In most studies, hypertensive arteriolopathy was the most common cause of both infarctions and hemorrhages.

Conclusions--Stroke has been poorly studied in South America. Available data suggest that the prevalence and incidence of stroke are lower than in developing countries. The pattern of stroke subtypes seems to be different from that reported in other regions of the world, with a higher frequency of cerebral hemorrhages, small-vessel disease, and intracranial atherosclerotic lesions. Such differences may be related to genetic, environmental, or sociocultural factors and to differences in the control of stroke risk factors.

Key words: epidemiology • ethnicity • incidence • intracerebral hemorrhage • prevalence • primary prevention • South America • stroke • stroke classification

This article has been cited by other articles:

				N L Cabral, A R R Goncalves, A L Longo, C H C Moro, G Costa, C H Amaral, L A M Fonseca, and J Eluf-Neto Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study J. Neurol. Neurosurg. Psychiatry, July 1, 2009; 80(7): 755 - 761. [Abstract] [Full Text] [PDF]

				P. Appelros, B. Stegmayr, and A. Terent Sex Differences in Stroke Epidemiology: A Systematic Review Stroke, April 1, 2009; 40(4): 1082 - 1090. [Abstract] [Full Text] [PDF]

				L. A. Sposato, M. M. Esnaola, R. Zamora, M. C. Zurru, O. Fustinoni, G. Saposnik, on behalf of ReNACer Investigators, and the Argentinian Neurological Society Quality of Ischemic Stroke Care in Emerging Countries: The Argentinian National Stroke Registry (ReNACer) Stroke, November 1, 2008; 39(11): 3036 - 3041. [Abstract] [Full Text] [PDF]

				C. Minelli, L. Fu Fen, and D. P. Camara Minelli Stroke Incidence, Prognosis, 30-Day, and 1-Year Case Fatality Rates in Matao, Brazil: A Population-Based Prospective Study Stroke, November 1, 2007; 38(11): 2906 - 2911. [Abstract] [Full Text] [PDF]

				F. J. Carod-Artal, S. V. Nunes, D. Portugal, T. V. F. Silva, and A. P. Vargas Ischemic Stroke Subtypes and Thrombophilia in Young and Elderly Brazilian Stroke Patients Admitted to a Rehabilitation Hospital Stroke, September 1, 2005; 36(9): 2012 - 2014. [Abstract] [Full Text] [PDF]

				O. H. Del Brutto, L. Idrovo, A. Mosquera, C. Navas, R. Santibanez, F. Cuesta, and E. Diaz-Calderon Stroke in rural Ecuador: A three-phase, door-to-door survey Neurology, November 23, 2004; 63(10): 1974 - 1975. [Abstract] [Full Text] [PDF]

				G. Saposnik, B. Young, B. Silver, S. Di Legge, F. Webster, V. Beletsky, V. Jain, Y. Nilanont, and V. Hachinski Lack of Improvement in Patients With Acute Stroke After Treatment With Thrombolytic Therapy: Predictors and Association With Outcome JAMA, October 20, 2004; 292(15): 1839 - 1844. [Abstract] [Full Text] [PDF]