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

Bladder dysfunction frequently accompanies a stroke but, with appropriate management, is not necessarily a permanent deficit. Voiding problems most often experienced after a stroke include urgency, frequency, incontinence, and urinary retention. A clamping routine prior to indwelling urinary catheter removal did not affect the incidence of voiding dysfunction after a stroke. Checking consecutive post-voided residual urine volumes after a stroke is indicated to evaluate the effectiveness of bladder emptying; intermittent sterile catheterization is recommended if there is a problem.
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PMID:Bladder dysfunction after a stroke--it's not always inevitable. 232 32

A retrospective case-control study within a cohort was carried out to identify factors associated with falling by patients in a rehabilitation hospital. The cohort comprised all patients admitted during a 2-year period from 1984 to 1986. Cases were those who fell one or more times during their hospitalization. For each case, one control matched on sex and date of admission, was chosen. Material from the first year of the cohort (201 cases and 201 controls) was used to define a model to estimate the risk of falling. Of the more than 100 variables considered in the conditional logistic regression models, stroke, incontinence, anticonvulsant medications, and topical eye preparations were significantly associated with the risk of falling. Analyses carried out on the second year of the cohort (155 cases and 155 controls) confirmed the predictive ability of these four variables. By combining the material from both subcohorts we were able to determine that a program to reduce falls directed towards stroke patients and incontinent patients alone could, theoretically, prevent 44% of first falls.
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PMID:Predicting falls among patients in a rehabilitation hospital. 273 Jul 82

Two patients with acute aortic thrombosis presented with painless paraplegia secondary to spinal cord infarction. In one case, the initial symptom was unilateral leg weakness, leading to the misdiagnosis of stroke. In the other case, a patient with a large, painful vulvar abscess, experienced spontaneous relief of pain. In the complete absence of pain, both patients slept undisturbed and awoke with complete paraplegia, incontinence, and cadaveric extremities. Aortic reconstruction was advised to obviate thigh or hindquarter amputation, not to restore limb function. One patient died on the second postoperative day; the second remains well but paraplegic two years later.
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PMID:Acute aortic thrombosis presenting as painless paraplegia. 274 42

A prospective study of 419 patients aged 70 and over admitted to acute medical wards was carried out by medical staff from a geriatric unit. Data, including presenting problem, housing, social support, mental state, continence, and degree of independence before and after admission, were recorded. Of the 419 patients, 143 remained in hospital after 14 days and 65 after 28 days. The major factors associated with prolonged stay in hospital included advanced age, stroke, confusion and falls as reasons for admission to hospital, incontinence, and loss of independence for everyday activities. Social circumstances did not predict length of stay. Although these factors are interrelated, the most important influence on length of stay was the medical reason for admission. Early contact with the geriatric medical unit in these patients may speed up the recovery or result in more appropriate placement.
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PMID:Elderly patients in acute medical wards: factors predicting length of stay in hospital. 308 1

By a retrospective relative risk analysis for conditions associated with urinary tract infection over a four-year period in a defined teaching nursing home population (n = 97), we reached the following conclusions: (1) UTI was associated with cerebrovascular accident (relative risk 2.2, 95% confidence interval 1.4 to 3.2), decreased activities of daily living (relative risk 2.6 to 3.2, 95% confidence interval 1.4 to 4.7), decreased mental status (relative risk 2.2, 95% confidence interval 1.2 to 3.1), urinary catheterization (relative risk 2.5, 95% confidence interval 1.3 to 3.7), and antibiotic prophylaxis (relative risk 2.1, 95% confidence interval 1.2 to 3.0). (2) Risk of UTI from urinary catheterization and antibiotic prophylaxis was additive for these functionally impaired patients. (3) Renal insufficiency, diabetes, anemia, malnutrition, age, and incontinence (without catheterization) were not related to risk of UTI.
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PMID:Antecedent factors in urinary tract infections among nursing home patients. 337 79

We evaluated in a standard fashion 375 patients presenting with complaints of memory loss. Etiology of memory loss included senile dementia of the Alzheimer type (SDAT)-70%, vascular dementia-5%, mixed dementia (SDAT + vascular)-9%, and other etiologies-16%. Incontinence, transient symptoms, and gait disturbances occurred more frequently in vascular dementia than in SDAT. A history of cardiovascular disease and stroke was more common in vascular dementia than SDAT. Disturbances of gait, bradykinesia, and pyramidal tract findings were commonly seen in vascular dementia. Advanced technology aided diagnosis in only 6% of patients and CT was the most useful of such tests. An earlier age of onset was noted in those with a positive family history of SDAT. Duration of symptoms at presentation for SDAT patients varied inversely with the rate of progression of dementia 15 to 55 months later, suggesting that individuals who progress more slowly require more time to elapse before the family or patient realizes the need for medical attention.
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PMID:Dementia: characteristics of a referral population and factors associated with progression. 338 27

Of 1,643 cranial computed tomography (CT) scans done in a primary-tertiary care private hospital over a 1-year period, 11 (0.67%) showed diffuse confluent white matter lucencies of less than 30 Hounsfield units. By retrospective analysis, at least 4 of the 11 were demented. Of these, 3 had clinical evidence of Binswanger's disease--characterized by progressive dementia, incontinence, variable pseudobulbar signs, and acute and subacute motor deficits. Two additional patients suffered only transient ischemic attacks or lacunar strokes; 2 had syncope; 1 had multiple sclerosis. The remaining patients were neurologically asymptomatic. In this small retrospective series, the severity of CT changes did not distinguish the patients with clinical Binswanger's syndrome from neurologically less symptomatic patients. Ten of the eleven patients had disordered blood pressure regulation--hypertension, labile systolic pressure, orthostatic hypotension, or a combination of these factors. The severity of CT changes correlated more clearly with blood pressure instability than with clinical encephalopathy. Asymptomatic adult patients with unexplained CT white matter hypodensity and blood pressure disorders may, however, be at risk for the development of subsequent subacute arteriosclerotic encephalopathy.
Stroke
PMID:White matter lucencies on computed tomography, subacute arteriosclerotic encephalopathy (Binswanger's disease), and blood pressure. 362 49

The incidence of incontinence in a series of 135 consecutive stroke patients was 51% (urine) and 23% (feces) within one year. In 75% the urinary incontinence started within the first two weeks, and in 41% it had cleared during that time. Incontinence at onset is associated with measures of severity of stroke (and of immobility for fecal incontinence). Among 92 survivors at one year, 15% were incontinent of urine, a proportion that rose in two- and three-year survivors to 23 to 24%, but by four years was again 14%, a level similar to that of the general elderly population. It is concluded that incontinence is more commonly a by-product of immobility and dependency than of involvement of the neurologic pathways, and most of it is transient.
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PMID:Incidence and correlates of incontinence in stroke patients. 401 99

This paper reviews the methodological issues in the epidemiological study of the outcome from stroke. Data are presented from an unselected series of patients in whom the underlying stroke pathology is clearly defined. Although the natural history varies among the different pathological subtypes of stroke, simple clinical baseline measures of the severity of the neurological deficit (incontinence, loss of consciousness and severity of paresis) and premorbid level of disability and social functioning independently predict disability-free survival by 1 year, and may help direct management and research.
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PMID:Baseline measures and outcome predictions. 780 Jan 6

Although diabetes is a common health problem of the elderly, the impact of diabetes on health and functioning in older persons is not well established. The purpose of this analysis was to identify health conditions accompanying diabetes in four samples of community dwelling elderly people. The study samples consisted of 13,601 persons ages 65 or older who participated in the Established Populations for Epidemiologic Studies in the Elderly (EPESE). Extensive interviews were conducted in respondents' homes to obtain information on diabetes and other health conditions, health behaviors, use of health services, and demographic characteristics. A lifetime history of diabetes was reported by 14 percent of respondents. The prevalence of the disease was higher in blacks than whites, especially among women. Persons with diabetes were more likely to report myocardial infarction, stroke, vision problems, physical disability, incontinence, and nursing home stays than persons without diabetes, but the diabetics were less likely to consume alcohol or tobacco. Those with diabetes were only slightly heavier than those without diabetes at the time of the interview. However, body mass at age 50 was substantially greater among persons with diabetes. Associations between diabetes and other health conditions and behaviors were similar for whites and blacks. These results show that aged persons with diabetes experience substantial comorbidity, which has important ramifications for functioning and survival.
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PMID:The health burden of diabetes for the elderly in four communities. 780 Jul 88


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