ABSTRACT

INTRODUCTION Many studies have clearly identified the risk factors for the development of
atherosclerosis as an independent risk factor for the development of cerebrovascular
oboljenja.Takoe clearly identified the importance of modifying the variable risk factors for
prevention and treatment of stroke.
OBJECTIVE The objective of this study was to investigate the presence of risk factors in patients
with stroke .
METHODS A group of 71 patients suffering from stroke , 35 women and 36 men , mean age
66.22 g plus minus 7.77 g . The diagnosis was made based on clinical, electrocardiographic ,
radilokih ( CT and MRI) criteria . RESULTS The average length of follow-up of all patients was
the most .......... 10 by at least three months . In men, the largest number of patients was 66 to
75 g , while for women this number is evenly distributed. Among the varying risk factors for first
representation hypertension ( 100 % ) followed by dyslipidemia , with only 16 % of patients with
lipid values within the reference group vrednosti.U dyslipidemia as a factor

OBJECTIVE : To evaluate the presence of risk factors as those to which we can not
influence , and those that can affect the population ill with cerebrovascular disorders .


METHOD
The study included 71 people with cerebrovascular disorders . 35 ( 49 %) women and 36 ( 51 %
) were men , average age ... 66.22 + - 7.77 years . Applied retrospectively trial that includes
patients who have suffered a stroke in the period from 2008 to 2013th All patients were treated
prior cerebrovascular insult in D. Z. Aryl and followed the prisistvo risk factors preiod from max to
min 10 yrs 3 months. . Djagnoze After placing cerebrovascular insult to the neurology ward of
the General Hospital Uzice then followed in D. Z - Arilje . The necessary data were obtained on
the basis of review of medical records of patients . The diagnosis of cerebrovascular disorders
was based on clinical, radiological ( CT and MRI) criteria . Premorbid health status was
monitored on the basis of clinical, laboratory , electrocardiographic , radiolokoih criteria .
Complete neurological diagnosis that includes a neurological examination with CT examination
and
required laboratory tests carried out in O. B. Uzice in the department of neurology , and in a few
cases outpatients by neurologists . Previous medical condition that is . the presence of risk
factors is accompanied by the D.Z. Aryl Department of General Medicine with the necessary
internship and subsspecijalistike consultation . The total patient population was divided into two
groups: men and women . Accompanied by the presence of certain risk factors by gender . Also
monitored is the presence of a risk factor in relation to the total population of patients . The
statistical analysis used the descriptive method , the mean value , tabular and graphic display ..
The observed differences in the frequency of parametric characteristics were measured by
Student's t test.

INTRODUCTION Cerebrovascular disease is caused by damage to the blood vessels of the
brain . Symptoms may develop suddenly or gradually . By definition, a stroke abruptly emerged
focal , non-convulsive neurological disorder in which besides vascular damage can reveal other
causes . We distinguish ischemic which is basically inadequate blood flow to part of the brain ,
and hemorrhagic stroke caused by ruptured krvniog Court and consequently the flow of blood to
the brain parenchyma or subarachnoid space .
Ischemic stroke is caused by cerebrovascular atherosclerosis , and posterior circu
cardiogenic embolisms . Ateroslerotska damage to the aortic arch , carotid bifurcation and
intracranial vessels have resulted in local thrombosis and distal embolization of blood vessels
. Embolization is more common in the basin a.cerebri artery thrombosis with a consequent
narrowing of the lumen and ischemia in the a . basilar . Embolization of cardiogenic sources
derived from red atrial thrombus , and the assumptions about the type of embolization obtained
on the basis of known data pretkomorskoj fibrillation , fresh myocardial infarction , prosthetic
heart valves , valvular or ischemic lesions kardimiopatiji . It is important to note that only 14 % of
patients with stroke and no one with heart disease . Lacunar ischemia caused by the pathology
of small perforating vessels of the brain ..
Hemorrhagic strokes occur in about 15 to 20 % of all strokes are caused by a intracerbralnom
or subarachnoid hemorrhage .Subarachnoid hemorrhage caused by ruptured aneurysm while in
intracerebralnoj in about 60% of a rupture of small blood vessels damaged hypertensive
arteriopathy . How do we know that stroke is the third cause of death and the first cause of
disability in developed countries, it is clear that it is probably the best therapy for stroke
identification risk factors that can then be corrected and the prophylactic effect .
Risk factors that we can not influence the gender, age, race , heritage . It is known that men
are more likely to suffer a stroke , and that after 55 years the risk doubles every decade . Impact
of inheritance explain how genetic factors and the impact of environment and lifestyle , which
inevitably lead to the risk factors that can be influenced. In this group, the most important is the
hypertension ( especially hemorrhagic stroke ) . Is considered to be a person who has
hypertension bolujeod three fold higher risk for stroke . Furthermore , there are atrial fibrillation
according to the research by the present in about 15obolelih % , heart disease and diabetes
mellitus , which increases the risk of about two times . Dyslipidemia increase the risk of ischemic
stroke and the cessation of smoking within the first year reduces the risk by 50 % . It is important
to note that a previous stroke or TIA increases the likelihood of a new stroke . Among the
potential risk factors are physical inactivity and obesity . Obviously, with all these risk factors
common denominator ateroskeroza as well as the fight against atherosclerosis also the fight
against stroke.
Risk aside a group of 50 patients with a mean cholesterol level was 6.078 . Been here is a
significant difference compared to the normal group ( the mean value holeserola 4.45) . t = 10.7
p less than 0.01 . With 99 % certainty claim that the average levels of cholesterol in the patient
group is significantly higher than the average value in the healthy group . Also , there is a
difference in the setting values of lipids in men and women and the so males posene values
were 6:45 and 5.88 in women . ( T = 2.382 for p less than 0.05 ) . Difference with 95 %
confidence was not significant , however, there was no statistically significant difference in mean
cholesterol for p less than 0.01 ) . As a source of cardiogenic embolism , atrial fibrillation is
present in 45% and valvular disease in 7 % of patients . Diabetes mellitus premorbid present in
16.9 % of patients . Previous stroke or TIA had 19.7 % of the patients . In the study population,
the average number of risk factors that can affect a 2:54 ( hypertension , dyslipidemia , diabetes
mellitus , valvular defect ) .
Conclusion This study demonstrated the ogrmoman impact of risk factors on the development of
cerebrovascular disease .Practically , the risk factors are present in all obolelih.Sve This
suggests the importance of correcting risk factors in the prevention of disease cebrovaskularnih .

RESULTS
From sale of fixed risk factors (gender and age ) it was observed that in men the highest
number of patients aged 66 to 75 years , in contrast, in women 's illness at ages evenly
distributed .



Figure 1 Number of patients ( by age ) of cerenrovaskularnog stroke in men and women

Among the factors of risk that can affect hypertension is present in all ( 100 % ) patients .
The following are the presence of dyslipidemia in a way that only 16 % of patients had lipid
values in the range . Dyslipidemia had a 69 % to 16 % of patients there was no data . Within the
group of risk factors like dyslipidemia is allocated a group of 50 patients with a mean value of
cholesterol was 6.078 . Has been here razlikau significant compared to the healthy group (mean
holeserola 4.45) . t = 10.7 p less than 0.01 . With 99 % certainty claim that the average levels of
cholesterol in the patient group is significantly higher than the average value in the healthy group
. I have compared the mean values of cholesterol in patients suffering men and women . In men
posene values were 6:45 and 5.88 in women . ( T = 2.382 to p less than 0.05 ) . Difference is
certainly 95 % was significant , but there was no statistically significant difference in mean living
for p less than 0.01 ) .



Figure 2 The lipid profile in patients

As a source of cardiogenic embolism , atrial fibrillation is present in 45% and valvular
disease in 7 % of patients . Diabetes mellitus premorbid present in 16.9 % of patients . Previous
stroke or TIA had 19.7 % of the patients . From the above percentage of the risk factors we note
that in patients at the same time there is more risk factors ( Figure 3 ) . In the study population,
the average number of risk factors that can affect a 2:54 ( hypertension , dyslipidemia , diabetes
mellitus , valvular defect ) .
hiperetnzija dyslipidemia , atrial fibrillation disease
valve diabetes mellitus previous
power. impact
Men 36 36 24 16 4 7 7
Women 35 35 25 16 6 5 7

Table No. 1 The presence of variable risk factors in men and women

Figure 3.Promenjivi risk factors are expressed as a percentage
DISCUSSION
Clinical manifestations of atherosclerosis are reflected in the failure of coronary , peripheral ,
cerebral and visceral circulation , and the strokes of target organs in the event of a complete
blockage of a blood vessel. In this paper we have dealt with the negative impact of
atherosclerosis on cerebral circulation and influence of risk factors on the development of
atherosclerosis in the light of the morbidity of stroke . Atheroma as the main substrate
pathoanatomically atherosclerosis is a thickening of the arterial wall which protrudes into the
lumen , Ssastoji of lipid substances , cholesterol , cell decay products , calcium , and fibrin .
Atherosclerosis is the most severe form of the degenerative process in the arteries,
arteriosclerosis .. which inevitably occurs during aging. It is the risk factor of crucial importance
for the development arterisokleroze the way that impair endothelial protective effect on blood
vessels . The most important factor that affects the blood vessel 's mechanical injury to the
endothelium and in places the highest turbulence levels : bifurcation and change of the lumen
. This makes carotid predilection sites for the development of atherosclerosis and consequently
a source of emboli in the cerebrovascular system . The cause of cardiogenic embolism there is
an increase in turbulence and endothelial damage due to atrial fibrillation and valvular anomalies
( . Verify ) .Thus, in the study population, the fibrillation was 45% and 7 % valvular defect .. factor
for stroke [ 11,12 ] . As two fundamental factors in the onset of stroke , hyper- tension and
atherosclerosis, and with each other to support the arterial hypertension leads to a reduction
vaskuloprotektivnog effects of endothelium as well as the thickening of the intimal hyperplasia
and media . It has been found that the hypertension was present in all patients which is
consistent with the fact that hypertension is the most important risk factor for stroke . The
hypertension increases the risk of stroke three times , and its successful treatment it decreases
by 50 % . .The increased activity of LDL cholesterol fractions a direct toxic effect on the
endothelium of reducing the synthesis of c AMPA by increasing thromboxanes with diabetes
mellitus and hyperglycemia , and hyperinsulinemia via growth factors stimulate the proliferation
and migration of smooth muscle cells from media to the intima .
In the study group dyslipidemia were second most frequent ( 69 % ) was that they were high
levels of triglycerides were holesterola.Znaajna is I zasupljenost patients without data on lipid
values prior cerebrovascular disorders ( 16 % ), so that there is only fifteen percent of patients
with values lipids within the reference values . Average values holeserolola The patients were
significantly higher than in healthy standing in line with great importance, cholesterol as a risk
factor for the development of atherosclerosis and consequently stroke. Further, the valvular atrial
fibrillation , and as a source of flaws cardiogenic embolism znaajnomprocentu present in as
follows: 45 % in atrial and valvular disease of approximately 7 % . The average number of
factors rzika that can affect a 2:54 which practically means that none of the patients of stroke
was not without any risk factors.
CONCLUSION
Results of this study showed a huge impact on the development of risk factors
cerbrovaskularnih disease is particularly important to single out the factors that cause
atherosclerosis : hiperetnzija , diabetes registry mellitus , heart disease , hierelipidemije and
previous stroke average number of risk factors of 2.54 per illness leads us to the conclusion
that the best approach to treating stroke prevention in fact . Modifikacjom risk factors could be
influenced by the consequence of reducing the morbidity and morbidity from stroke .