Abstract and Introduction
Abstract
Background To predict the outcome of stroke at an acute stage is important but still difficult. Vomiting is one of the commonest symptoms in stroke patients. The aim of this study is threefold: first, to examine the percentage of vomiting in each of the three major categories of strokes; second, to investigate the association between vomiting and other characteristics and third, to determine the correlation between vomiting and mortality.
Methods We investigated the existence or absence of vomiting in stroke patients in the Kyoto prefecture cohort. We compared the characteristics of patients with and without vomiting. We calculated the HR for death in both types of patients, adjusted for age, sex, blood pressure, arrhythmia, tobacco and alcohol use and paresis.
Results Of the 1968 confirmed stroke patients, 1349 (68.5%) had cerebral infarction (CI), 459 (23.3%) had cerebral haemorrhage (CH) and 152 (7.7%) had subarachnoid haemorrhage (SAH). Vomiting was seen in 14.5% of all stroke patients. When subdivided according to stroke type, vomiting was observed in 8.7% of CI, 23.7% of CH and 36.8% of SAH cases. HR for death and 95% CI were 5.06 and 3.26 to 7.84 (p<0.001) when all stroke patients were considered, 5.27 and 2.56 to 10.83 (p<0.001) in CI, 2.82 and 1.33 to 5.99 (p=0.007) in CH and 5.07 and 1.87 to 13.76 (p=0.001) in SAH.
Conclusions Compared with patients without vomiting, the risk of death was significantly higher in patients with vomiting at the onset of stroke. Vomiting should be an early predictor of the outcome.
Introduction
It is well known that vomiting is often seen at the onset of stroke even without accompanying nausea. It is more often seen in haemorrhagic stroke than in ischaemic stroke patients. However, quantitative data on the frequency of vomiting at stroke onset remain unclear. Causes may include brain swelling, increased intracranial pressure and meningeal stimulation. Although it is not a specific symptom indicating the localisation, nor the exact nature of the lesion, it may be very important if it correlates with the outcome. As it is a finding noticeable by anyone, it may urge patients and their families to visit a doctor or call an ambulance. For paramedics and physicians as well, a prompt indicator of the severity of stroke is of great concern. Predicting the outcome of a stroke is important and much effort has been spent to determine major elements for predicting prognosis. Arboix et al reported nausea/vomiting as a predictor of early mortality for an ischaemic stroke in people without diabetes. However, the HR for death in stroke patients with vomiting, compared with that in patients without vomiting, has not been estimated. Predictors applicable in the clinical setting, particularly in the first 6 h of stroke onset, are not yet fully available. Vomiting, although a non-specific symptom, is a good candidate for one of the predictors.
The aim of our study is to determine the following three points: first, the frequency of vomiting at stroke onset; second, differences in characteristics between patients who vomited at stroke onset and patients who did not; and third, whether vomiting is correlated with early stroke death.
If the occurrence of vomiting is high enough at stroke onset, it may be that vomiting is an important symptom as a prompt identifier at emergency care. Whether certain characteristics of stroke patients are related to vomiting or not is also of interest. It may give us additional information on the background, and, if mortality of patients with vomiting is higher than in patients without vomiting, this symptom could be a predictor of the stroke outcome.