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

Neuroleptic malignant syndrome is characterised by muscular rigidity, fever and signs of severe vegetative nervous system involvement. Its etiopathogenesis is still unclear and the disease is potentially fatal. Its clinical aspects, which are often only partially manifested, make it difficult to formulate a correct diagnosis in time, not least due to the problem of differential diagnosis with other syndromes with similar symptoms but a different pathogenesis, psychopathology and therapy: acute lethal catatonia, fatal acute delirium, heat-stroke, malignant hyperthermia. The speed of the diagnosis is vital for effective therapy, but this is made even more difficult by the need approach. The paper presents eleven case studies; after an analysis of the numerous clinical aspects of the syndrome and the definition of its diagnostic parameters, an appropriate therapeutic protocol is outlined. Lastly, the problem of retreatment using a neuroleptic of the same or a different class is discussed once the acute phase has been overcome.
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PMID:[Neuroleptic malignant syndrome and related conditions]. 136 74

Earlier works have documented a high incidence of affective disorders in patients with a history of a cerebrovascular accident (CVA). In general, electroconvulsive therapy (ECT) has been reported to be effective in treating depressed patients with a history of CVA. Recent works have shown that preexisting structural brain changes may predispose patients to develop interictal ECT-induced delirium. However, the incidence of ECT-induced interictal delirium in patients with a history of CVA has not been directly studied. In this pilot study, the authors examined the incidence of ECT-induced interictal delirium in 14 depressed CVA patients compared with 14 elderly depressed controls (without a history of CVA). Interestingly, the overall incidence of delirium was identical in both groups (28.5%). However, consistent with previous works, some patients who had had a recent CVA involving the caudate nucleus appeared more likely to develop delirium. Thirteen of the 14 depressed CVA patients (92%) showed a moderate to significant improvement in their depressive symptoms from ECT. None of the patients developed significant cardiac complications during ECT.
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PMID:ECT-induced interictal delirium in patients with a history of a CVA. 149 92

Aspirin (acetylsalicylic acid) and its salicylate derivatives are effective antipyretic, analgesic, and anti-inflammatory agents that are still very widely used by the elderly despite the advent of newer, potentially safer nonsteroidal anti-inflammatory drugs (NSAIDs). However, none of the new NSAIDs have been proven to be more effective than aspirin or salicylic acid. Chronic salicylate intoxication which is most common in the elderly, may occur with therapeutic doses. Increased toxicity in older patients often appears due to inadvertent overdosage. Dual prescribing or additional use of nonprescription salicylates are some causes of unwitting long term toxicity. According to some studies, systemic clearance of salicylate (mainly by hepatic metabolism) is reduced with age, as is renal elimination. These changes are of increased importance in the elderly using high therapeutic doses of salicylates when metabolism is saturated and more unchanged drug is available for renal excretion. In the face of renal impairment, the risk of toxicity is increased. The diagnosis of acute salicylate intoxication generally does not pose diagnostic problems. Patients often present with a history of intentional overdose, with hyperventilation, fever, and nausea. The diagnosis can be confirmed by measuring serum salicylate concentrations. Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction or cardiac failure. The diagnosis of salicylate intoxication should be borne in mind when an older patient presents with recent deterioration in activities of daily living with no known cause. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there is no documented history of salicylate ingestion. The risk of salicylate nephrotoxicity is also increased with age, and upper gastrointestinal haemorrhage is associated with increased mortality in older age groups. Treatment of acute toxicity consists of prompt recognition of salicylate intoxication, use of activated charcoal, correction of acid-base abnormalities, general supportive measures, and if concentrations are extremely high, dialysis can be effectively used. Chronic toxicity, which can occur even with marginally high salicylate concentrations, is treated with drug withdrawal and supportive therapy. Chronic salicylate toxicity can be averted by prescription of conservative doses of drug, avoidance of concomitant use of different salicylate preparations, and therapeutic monitoring to guide dosage. Renal function should be monitored to detect nephrotoxicity from chronic salicylate therapy. Patients should be regularly screened for evidence of gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it. 155 71

The prevalence, associated conditions and outcome of delirium were studied in a consecutive series of 184 patients admitted with acute illness to a department of health care of the elderly. Forty of these elderly subjects (22 per cent) met Diagnostic and Statistical Manual version 3 (revised) criteria for delirium. Screening for delirious patients using the abbreviated mental test on admission gave a high sensitivity (92 per cent). The conditions most commonly associated with delirium were infection and stroke. Onset of acute illness of less than 15 days, a reported history of dementia or recent confusion, and presence of a definite site of infection were much more likely in those with delirium. Serial use of the abbreviated mental test was a sensitive means of distinguishing delirious from other patients and may be useful in both the clinical and research setting. Delirious patients had more serious pre-existing disease than non-delirious patients. They had a higher number of admissions during the 2 years prior to the index admission, a higher mortality rate and a higher rate of transfer to long-stay care than other patients, but no difference in duration of admission. All acutely ill elderly people should undergo an abbreviated mental test on admission, and if abnormal, this should be repeated as it will aid detection of delirium.
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PMID:Delirium in newly admitted elderly patients: a prospective study. 163 Dec 62

Thirty-one consecutive cases of intracerebral hemorrhage (ICH) in the elderly (over 70 years at the onset) were reported with special reference to neurological evaluations, prognosis and mortality in the acute phase. There were 11 men and 20 women with ICH, who were admitted to the Yokufukai Geriatric Hospital within 24 hours after the onset of ICH. Their ages at the onset ranged from 71 to 93 years with a mean of 81.1 years. The lesion location showed 5 cases with thalamic hemorrhage, 4 cases with putaminal hemorrhage, 6 cases with subcortical hemorrhage, 7 cases with cerebellar hemorrhage, 8 cases with mixed hemorrhage and 1 case with unclassified hemorrhage. 61.3% of all cases showed the onset during daytime but the remaining awoke in the morning with their symptoms or had the onset from the stage of the bedridden state. The classical prodromal symptoms headache and nausea or vomiting were found in 30% and 54.8%, respectively. Two cases with cerebellar hemorrhage were accompanied by vertigo. Twenty-four patients had consciousness disturbance at admission. There were 18 cases with right or left hemiparetic symptoms, 5 cases with tetraparesis, and 5 cases without motor dysfunction. The remaining already had hemiparesis due to old stroke. Patients with mixed hemorrhage usually exhibited conjugate deviation. In 9 of 31 cases there were mental symptoms such as wandering or night delirium. The 30-day mortality rate was 64.5% and sixty-five percent of them died within 6 days after the onset of ICH. Consciousness at admission was the overwhelming predictive factor.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cerebrovascular disease in the elderly--clinical study of 31 cases with acute intracerebral hemorrhages]. 224 24

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

The occurrence of central nervous system (CNS) complications was studied retrospectively in 150 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococci or Escherichia coli. The incidence and clinical manifestations of different CNS complications were noted during 1 month after the bacteremia. Special attention was paid to vascular complications (infarction or hemorrhage), infections (meningitis or brain abscess) and mental changes when they were the only signs of CNS origin (lowered level of consciousness, confusion or delirium). The risk of cerebral infarction was elevated in the patients with bacteremia during the first month after the positive blood culture as compared with the overall risk of stroke in the general population. 10/150 patients (7%) developed cerebral infarction during that month. Two of these cases were associated with bacterial meningitis and 1 with endocarditis. Mental changes as a main symptom of CNS origin occurred in 27% of patients with bacteremia. Increasing patient age predisposed to this complication. Mental changes were not associated with any bacterial species studied. Altogether 40% of the patients developed CNS complications, which were a significant risk factor for death during the first month after the bacteremia.
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PMID:Central nervous system complications in patients with bacteremia. 266 96

Seventy elderly patients meeting the DSM-III criteria for delirium were examined during the acute stage and followed up to one year. The mean age of the patients was 75 years (range 60-88), their delirium lasted on average 20 days (range 3-81) and the psychiatric hospitalization on average 30 days (range 8-365). The most common etiologies for delirium were stroke, infections and metabolic disorders. For 57 cases (81%) a predisposing structural brain disease was found. During the index admission, the cognitive dysfunction associated with delirium ameliorated significantly (the mean +/- SD Mini-Mental State Examination score 9.7 +/- 6.6 at admission and 13.9 +/- 7.2 at discharge; P less than 0.001), but during the one-year follow-up progression of the basic central nervous system disease was seen together with declining cognition and deterioration of functions of daily living.
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PMID:Delirium among elderly persons admitted to a psychiatric hospital: clinical course during the acute stage and one-year follow-up. 276 53

The incidence of postoperative delirium was assessed in 92 patients on a general surgical intensive care unit. Postoperative delirium was diagnosed in 39 patients (42%). Most of the cases were diagnosed on the second postoperative day and the median duration was seven days. Ten patients with delirium (25%) had a lethal outcome, compared to a 13% mortality of the whole population. In univariate analysis the variables age, preoperative therapy for heart failure, respirator therapy, dobutamin therapy and lowest capillary pO2 on day one were significantly associated with later development of delirium, whereas preoperative peritonitis, and history of stroke or hypertension were only borderline significant. A predictive model with three parameters emerged from multiple logistic regression analysis: after correction for age (p = 0.001), respirator therapy (p = 0.020), and capillary pO2 on day one (p = 0.049) none of the remaining variables proved of additional significance. The statistical model yielded a predictive accuracy of 78%.
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PMID:[Acute postoperative psychosyndromes. A prospective study and multivariate analysis of risk factors]. 279 33

Strokes can be due to ischemic or hemorrhagic vascular disorders. Ischemic strokes outnumber hemorrhagic strokes approximately 4:1. Although the mode of presentation and pathophysiology are different in the two conditions, the outcome is really dependent on the extent and location of brain injury. A CT scan helps in this regard and reveals surgically correctable lesions such as a subdural hematoma or normal pressure hydrocephalus. Effective rehabilitation of the stroke patient is dependent on motivation and cognitive ability even more than on remaining motor or sensory function. A team approach to assessment provides the opportunity to make an accurate appraisal of a patient's current level of functioning and an estimate of premorbid capabilities. A thorough review of the history, complete neurologic examination, mental status testing, and laboratory and radiographic data should be obtained by the treating physician. Neuropsychologic testing, speech and language evaluation, ADL assessment, nursing observations, and psychiatric consultation round off the attempts to fully learn the limitations and strengths that characterize the patient. The value in assessing cognitive abilities after a stroke should be obvious. Not only is motivation necessary, but the patient must comprehend the purpose of the rehabilitation process. Goal-setting is a combined effort of the patient and the rehabilitation team. If a patient has limited understanding and faulty memory, the efforts may be wasted. The presence of acute confusion or delirium may delay rehabilitation efforts, but the etiology may be readily treatable. When there is strong suspicion of a degenerative dementia such as Alzheimer's disease, the expectations are lowered. Occasionally, the problem is a mixed dementia in which instance the prognosis is poor. When there is evidence for multi-infarct dementia, there is a possibility for cognitive improvement when medical problems such as hypertension and embolization are treated. Much can be done for one who has limited and focal cerebral damage provided there is adequate comprehension and ability to compensate for disability.
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PMID:Dementia following stroke. 306 59


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