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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Substance misuse contributes directly or indirectly to each of the 5 key targets outlined in the Health of the Nation strategy: coronary heart disease and stroke, cancers, mental illness, HIV/AIDS and accidents. More specifically, the risk factor targets include a 30% reduction in the prevalence of cigarette smoking to no more than 20% in both men and women by the year 2000; a 30% reduction in the proportion of men drinking more than 21 units of alcohol per week and women drinking more than 14 units per week to 18% and 7% respectively, and reduction in the percentage of drug misusers sharing equipment to no more than 5% in the year 2000. The Tomlinson report repeatedly underscores the problems of drug misuse, alcohol problems and mental illness in Inner London. Both these recent reports admit to a 'lack of trained professionals' (p17) and to 'ensuring that professionals ... are adequately and appropriately educated' (p97). Furthermore, Health of the Nation declares that 'Professional bodies in health and social work will continue to design training to promote the early identification of alcohol misuse, and appropriate referral skills' (p16).
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PMID:Alcohol misuse as challenge to medical education: a belated remedy. 814 91

The demographic, health, and mental functioning characteristics of nonresponders to a community-based cross-sectional study of cognitive functioning among the elderly in Amsterdam, the Netherlands (Amsterdam Study of the Elderly (AMSTEL), October 1990 to May 1991), were examined and compared with responders. The randomly selected age-stratified (65-74, 75-84 years) sample was drawn from nonresponders listed with a subsample (n = 8) of general practitioners whose lists served as the sampling frame for the main study. The general practitioners approached and interviewed the responding nonresponders using the same standardized questions that were used in the main study. Nonresponders (n = 115) and responders (n = 999) from the same medical practices were compared by means of chi-square and odds ratios. Compared with responders, these nonresponders more often reported a history of psychiatric illness, heart attack, stroke, and diabetes, and were more likely to be unmarried, to have a lower education, and to do poorly on the cognitive test (odds ratio = 1.6, 95% confidence interval 1.0-2.6). Most significant physical and mental health differences by response status were seen among the persons aged < 75 years and not among those aged > or = 75 years. The odds for poor cognitive test performance associated with age and stroke were relatively more biased than those associated with other risk factors. These results suggest that the characteristics of young-old and old-old elderly nonresponders to cross-sectional studies of cognitive function may differ, and that there may be selective nonresponse that could bias, to a different degree, estimates of risk for poor cognitive functioning. Studies should investigate the possibilities for nonresponse in their own setting.
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PMID:Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. 817 93

We describe the appearance of left hemineglect and striking cataleptic posturing, more prominent in left-sided extremities, in a patient without psychiatric illness. Neuroimaging demonstrated a large posterior right hemisphere infarct involving the parietal, occipital, and temporal lobes, the insula, and caudate. Additional movement abnormalities that comprise the full catatonia syndrome were absent, including stereotypy, mannerisms, ambitendency, automatic obedience, mutism, negativism, and echopraxia. Catatonia has been reported to be produced by lesions of diverse etiology affecting the frontal lobe, limbic system, diencephalon, or basal ganglia. In these cases, catalepsy has been manifest only rarely, and motor signs that are present are generally bilateral. This case demonstrates that asymmetric catalepsy can be produced by right hemisphere stroke, and provides partial support for earlier clinical literature relating catalepsy and the parietal lobe.
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PMID:Asymmetric catalepsy after right hemisphere stroke. 841 10

The relationship between extrapyramidal sign (EPS) severity and cognitive function was investigated in 184 patients with idiopathic Parkinson's disease (PD) and 301 normal elderly individuals from a community-dwelling cohort in northern Manhattan, New York City. Fifty-six of the patients with PD met criteria for dementia of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, and of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. EPS were rated according to the Unified Parkinson's Disease Rating Scale. Cognitive function was assessed by neuropsychological tests of memory, orientation, abstract reasoning, language, construction, and psychomotor speed. Significant associations were found between EPS and neuropsychological performance in PD patients without dementia. Yet EPS severity was unable to account for the pronounced cognitive impairment in PD dementia. Individuals in the normal group with subtle EPS, but without overt idiopathic PD, showed widespread cognitive changes, including impairment in most of the tests that differentiated PD patients from normal subjects. Prospective follow-up of these individuals will determine whether this represents a preclinical stage of PD or constitutes an early manifestation of dementia.
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PMID:Relationships between extrapyramidal signs and cognitive function in a community-dwelling cohort of patients with Parkinson's disease and normal elderly individuals. 849 10

The frequency and correlates of the catastrophic reaction (CR) were examined in 52 consecutive patients with an acute stroke lesion. A new scale proved reliable for measuring the severity of CR. The CR was significantly associated with depression, a personal and family history of psychiatric disorder, and subcortical lesions, which were mostly located in the basal ganglia. Patients with and without a CR, when matched for the presence and type of depression, differed only in that CR patients had significantly more anterior lesions and a significantly higher frequency of subcortical damage. Results demonstrate that the CR is significantly associated with poststroke depression and may be a specific manifestation of certain types of poststroke depression.
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PMID:Catastrophic reaction after cerebrovascular lesions: frequency, correlates, and validation of a scale. 850 37

Status epilepticus (SE) is one of the most common neurologic emergencies in children, adolescents, and young adults. SE may be due to acute neurologic conditions such as meningitis, encephalitis, or stroke, complicated febrile seizures, intractable epilepsy, degenerative diseases, intoxication, or may be the first manifestation of epilepsy. Initial treatment of convulsive SE is usually with an intravenous benzodiazepine (BZD) [lorazepam (LZP) or diazepam (DZP)], phenobarbital (PB), or phenytoin (PHT). LZP is less likely to cause respiratory depression than DZP and is therefore preferred. Sequelae and risk for recurrence of SE are primarily related to the underlying cause. Refractory SE (RSE) is most often symptomatic of an acute neurologic condition or neurodegenerative disease. Treatment for RSE is difficult, usually requiring intensive support of vital functions. Reported treatments for RSE include very high dose PB, continuous infusions of pentobarbital or BZDs (DZP, midazolam), lidocaine, inhalation anesthesia, and propofol. Outcome is related to underlying cause. Nonconvulsive SE may present as confusion or may mimic psychiatric illness. Response to BZDs is usually rapid but may not be sustained. Rapid initiation of oral or rectal valproate may be useful. Epilepsia partialis continua (EPC) is almost always due to an acute or chronic destructive lesion. Surgical treatment may be the only effective modality in some children with EPC. Acute treatment of breakthrough seizures and clusters of seizures at home with rectal BZDs (usually DZP, 0.2-0.5 mg/kg) may prevent progression to SE in some children and adolescents and reduce the need for visits to emergency facilities.
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PMID:Status epilepticus and acute repetitive seizures in children, adolescents, and young adults: etiology, outcome, and treatment. 864 55

Standardization of diagnostic procedures for cognitive impairment in large epidemiologic surveys remains difficult. This paper reports results of diagnostic standardization in a subsample of 2,914 elderly (age 65 years+) Canadians from the Canadian Study of Health and Aging (CSHA; n = 10,263). The objectives were to measure the consistency of the CSHA diagnosis as a test of validity; to assess inter-rater reliability, and to assess the impact of neuropsychological data on the diagnosis of dementia. The CSHA clinical assessment included a nurse's examination, Modified Mini-Mental Status (3MS) exam and Cambridge Mental Disorders Examination, neuropsychological tests, medical history and examination, and laboratory investigations. A final diagnosis was reached in a consensus conference which incorporated preliminary diagnoses from both physicians and neuropsychologists. Computer algorithms, which were developed to check consistency between the clinical observations and the final diagnosis, demonstrated 98% concordance with DSM-III-R criteria for dementia and 92% with NINCDS-ADRADA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for probable Alzheimer's disease. Inter-rater agreement was high: kappa = 0.81 for dementia/no dementia; kappa = 0.74 for normal/cognitive impairment, not dementia/ dementia. Comparisons of diagnoses between raters by clinical specialty revealed few systematic differences. The impact of neuropsychological input on the physician's diagnosis was most marked in the borderline cases between diagnostic categories.
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PMID:Standardization of the diagnosis of dementia in the Canadian Study of Health and Aging. 887 77

Persons with persistent, disabling mental illness have an increased risk of heat-related illness. Mental health care providers must be aware of this risk, and should be educated regarding detection and prevention. A high level of awareness and monitoring for symptoms of heat-related illness is indicated during the initial days of a heat wave. Health professionals must ensure that consumers know about the risk of heat stroke and have a plan in place to deal with hot weather. Plans must be practical, affordable, and take into account the preferences, habits, and psychiatric symptoms of the individual who will carry them out. Thoughtful planning and education can help reduce the risk of heat-related illness in this vulnerable group.
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PMID:Heat stroke. Keeping your clients cool in the summer. 924 18

In a prospective study of more than 200 cases of dementia and 119 controls, annual technetium-99m-hexamethyl-propylene amineoxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) and annual medial temporal lobe (MTL) oriented X-ray computed tomography (CT) have been used to evaluate the diagnostic potential of functional and structural neuroimaging in the differential diagnosis of dementia. Some subjects have had up to 7 annual evaluations. So far, of 151 who have died, 143 (95%) have come to necropsy. Histology is known for 118, of whom 80 had Alzheimer's disease (AD), 24 had other "non-AD" dementias, and 14 controls with no cognitive deficit in life also had no significant central nervous system pathology. To compare the findings in the dementias with the profile of structural and functional imaging in the cognitively normal elderly, scan data from 105 living, elderly controls without cognitive deficit have also been included in the analysis. All clinical diagnoses were according to National Institute of Neurological and Communicable Disease and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria, and all histopathological diagnoses according to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria. Early data from this cohort have suggested that the combination of both MTL atrophy seen on CT with parietotemporal hypoperfusion on SPECT may predict the pathology of AD. The diagnostic sensitivity, specificity, accuracy, and positive and negative predictive values of the NINCDS-ADRDA and DSM-III-R criteria could be assessed in this cohort against the gold standard of histopathology. The diagnostic potential of CT evidence of MTL atrophy alone, SPECT evidence of parietotemporal hypoperfusion alone, and the combination of both of these scan changes in the same individual could then be compared against the diagnostic accuracy of clinical operational criteria in the pathologically confirmed cases. Furthermore, all of these modalities could be compared with the diagnostic accuracy of apolipoprotein E4 (Apo E4) genotyping to predict AD in the histopathologically confirmed cohort. In this population, NINCDS "probable-AD" was 100% specific, 49% sensitive, and 66% accurate; "possible-AD" was only 61% specific, but 93% sensitive and 77% accurate; and the combination of both "probable-AD" and "possible-AD" was 61% specific, 96% sensitive, and 85% accurate. DSM-III-R criteria were 51% sensitive, 97% specific, and 66% accurate. In the same cases and including the 105 living, elderly controls, the diagnostic accuracy of the Oxford Project to Investigate Memory and Aging (OPTIMA) scanning criteria showed CT alone to be 85% sensitive, 78% specific, and 80% accurate; SPECT alone had 89% sensitivity, 80% specificity, and 83% accuracy; and the combination of the two was 80% sensitive, 93% specific, and 88% accurate. The Apo E4 genotype was 74% sensitive but yielded 40% false positives in the histologically confirmed series. The diagnostic accuracy afforded by this method of CT and SPECT used alone is better than that of any established clinical criteria and reveals that the combination of MTL atrophy and parietotemporal hypoperfusion is common in AD, much less common in other dementias, and rare in normal controls. In the NINCDS-ADRDA criteria "possible-AD" cases, the combination of CT and SPECT findings alone were better in all diagnostic indices than the presence of Apo E4 alone in predicting AD. The frequent occurrence of MTL atrophy in AD and also in other "non-AD" dementias later in the course of the disease suggests the concept of medial temporal lobe dementia. This could explain some of the overlap of clinical profiles in the dementias, particularly as the dementia progresses, making clinical differential diagnosis difficult. In this context, the use of SPECT can significantly e
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PMID:Accurate prediction of histologically confirmed Alzheimer's disease and the differential diagnosis of dementia: the use of NINCDS-ADRDA and DSM-III-R criteria, SPECT, X-ray CT, and APO E4 medial temporal lobe dementias. The Oxford Project to Investigate Memory and Aging. 978 48

The study of discrete organic cerebral lesions resulting in clearly definable psychiatric disorders may provide an understanding of the underlying pathophysiological basis of these disorders. However, the relation between lesion location and psychiatric illness after stroke remains unclear. Fifty five patients referred to hospital were identified who had a single lesion on CT which was consistent with their neurological presentation and who did not have evidence of a persistent affective disorder at the time of the stroke. Six months after stroke standardised psychiatric assessment disclosed that 26% of the patients met DSM-IV criteria for an anxiety or depressive disorder, with depression the most common diagnosis (20%). Pathological emotionalism was diagnosed in 18% of patients, particularly those who were depressed (p<0.0001). Depression was significantly associated with larger lesions involving the right cerebral hemisphere (p=0.01). The importance of depression as a consequence of stroke has been clarified by the studies in this area. However, wide confidence intervals support the possibility that significant results may be due to chance. A systematic review of these studies is now needed if a consensus is to be reached.
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PMID:Depression and its relation to lesion location after stroke. 952 52


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