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

The validity of a clinical classification system was assessed for subtypes of cerebral infarction for use in clinical trials of putative stroke therapies and clinical decision making in a population based stroke register (n = 536) compiled in Perth, Western Australia in 1989-90. The Perth Community Stroke Project (PCSS) used definitions and methodology similar to the Oxfordshire Community Stroke Project (OCSP) where the classification system was developed. In the PCSS, 421 cases of cerebral infarction and primary intracerebral haemorrhage (PICH), confirmed by brain imaging or necropsy, were classified into the subtypes total anterior circulation syndrome (TACS), partial anterior circulation syndrome (PACS), lacunar syndrome (LACS), and posterior circulation syndrome (POCS). In this relatively unselected population, relying exclusively on LACS for a diagnosis of PICH had a very low sensitivity (6%) and positive predictive value (3%). Comparison of the frequencies and outcomes (at one year after the onset of symptoms) for each subgroup of first ever cerebral infarction in the PCSS (n = 248) with the OCSP (n = 543) registers showed uniformity only for LACI. For example, there were 27% of cases of TACI in the PCSS compared with 17% in the OCSP (difference = 10%; 95% confidence interval (95% CI) 4% to 16%) and 15% of cases in the PCSS compared with 24% in the OCSP were POCI (difference = 9%; 95% CI 3% to 15%). Case fatalities and long-term handicap across the subgroups were not significantly different between studies, but the frequencies of recurrent stroke were significantly greater for POCI in the OCSP compared with the PCSS. Although this classification system defines subtypes of stroke with different outcomes, simple clinical measures-level of consciousness, paresis, disability, and incontinence at onset-are more powerful predictors of death or dependency at one year. It is concluded that simple clinical measures that reflect the severity of the neurological deficit should complement this classification system in clinical trials and practice.
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PMID:Validation of a clinical classification for subtypes of acute cerebral infarction. 793 76

Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.
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PMID:Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. 843 86

Attempts to reduce the future demand for institutional care through community services are likely to have limited success. For this reason, health professionals must focus on preventing or ameliorating functional decline in older persons. To focus attention on this aspect of the geriatric imperative, we use an epidemiologic model to estimate the potential impact of existing or potential medical and public health interventions that might decrease the incidence of functional decline. For at least three major causes (stroke, hip fracture, and incontinence) of disability, the potential exists for reducing the incidence and burden of functional disability by a number of mechanisms. For example, treating just half of adults age 65-74 with currently untreated diastolic or isolated systolic hypertension would reduce the incidence of stroke by 2.77% in this age group (or 1,500 fewer cases of stroke annually). The estimates presented indicate the need (1) to better implement those interventions that are known to be efficacious, and (2) to identify and to test new interventions for conditions contributing to functional impairment in the elderly.
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PMID:The geriatric "medical and public health" imperative revisited. 841 28

The outcome and predictors of stroke rehabilitation were studied prospectively in 96 patients (mean age 81.3 +/- 5.4 years) admitted to geriatric wards from a well-defined area over one year. Of these, 32 (33%) died (median survival 11 days), 52 (54%) returned home (median hospital stay 69 days) and 12 (13%) required long-term care (median hospital stay 164 days). Deaths and discharges showed a bimodal pattern; nearly 40% of the patients died or were discharged within 2 weeks of admission. Early death correlated with level of consciousness (P = 0.02), neurological deficit (P = 0.01) and prestroke Barthel scores (P = 0.04) on admission. Patients with right- rather than left-sided hemiparesis (P = 0.02), good motor power (P = 0.002) and without sensory deficit/inattention (P = 0.002) were discharged early. Discharge home was adversely affected by poor awareness of deficit (P = 0.02), hemianopia (P = 0.03) and incontinence (P = 0.02) assessed at 2 weeks. Stroke survivors with Barthel score < 6 and Mental Test Score < 4 at 2 weeks after stroke required long-term care.
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PMID:Stroke in patients aged over 75 years: outcome and predictors. 844 47

Age-related changes, for example reduced elasticity and earlier airways collapse, predispose the elderly to respiratory infection. Other factors such as a lifetime of smoking, the use of hypnotics, or the development of stroke also predispose. Pneumonia becomes increasingly common with advancing age, and both morbidity and mortality increase with associated disease burden. Diagnosis of pneumonia may be more difficult in the aged because of physiological changes. However, careful physical examination with accurate, regular recording of body temperature will usually reveal the characteristic features of pneumonia, which should be confirmed by chest radiograph. In the frail elderly, the onset of impaired function, such as confusion, immobility, falling or incontinence, should raise suspicion of infection. Pneumonia is classified as community-acquired, nursing home-acquired or nosocomial, which helps in the empirical choice of antibiotics. Streptococcus pneumoniae is the most common organism in the community, then Haemophilus influenzae and Branhamella catarrhalis. Gram-negative organisms like Klebsiella and Escherichia coli are more common in nosocomial infections. Nursing home patients with pneumonia tend to be more frail than those in the community. Treatment is directed at eradication of the organism with the appropriate antibiotic, maintaining hydration and oxygenation, as well as managing impaired mobility, faecal loading, urinary incontinence and confusion. Influenza vaccination is strongly recommended for the frail elderly. Tuberculosis remains an important diagnosis in the frail elderly and should always be considered, especially in patients with respiratory infection who fail to respond to conventional therapy.
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PMID:Treatment recommendations for respiratory tract infections associated with aging. 845 84

In a retrospective study, based upon doctors' and nurses' case records, urinary incontinence (UI) and its relation to the severity of strokes was studied in 156 stroke patients discharged from the department of neurology, Bispebjerg Hospital in 1988. A significant relationship was found between the presence of UI and stroke severity measured by length of hospital stay, circumstances of discharge and mobility (p < 0.0001). 44% of patients had some urinary incontinence on admission and on discharge 26% still had UI. Surprisingly, however, information about incontinence appeared in only 10% of doctors' records, whereas nurses, records had the relevant information concerning as many as 90% of patients. It appears that urinary incontinence in stroke patients has a low priority among doctors.
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PMID:[Urinary incontinence after apoplexy]. 848 96

Between 1971 and 1991, 41 patients underwent anterior resection for the treatment of complete rectal prolapse. Anterior resection was performed after full rectal mobilization to the levator ani muscles with reanastomosis (39 hand-sewn and two stapled) carried out to peritonealized distal rectum. The 41 patients comprised 35 women and six men with an average age of 56 years (range, 7-88 years). Postoperative follow-up averaged 6 years (range, 6 months to 18 years). Three patients (7%) suffered recurrent prolapse in 2, 2.5, and 5.5 years, respectively. Mortality was 0 per cent; morbidity was 15 per cent including three incisional herniae, two small bowel obstructions, and one stroke. No pelvic sepsis, abscess, or anastomotic dehiscence occurred. Anal incontinence was a preoperative finding in 21 patients (51%) with rectal prolapse. Nineteen of these patients (90%) noted either improvement or no change in postoperative continence. Anterior resection is a familiar, frequently performed operation that does not require a foreign body or rectal suspension. We believe this to be the procedure of choice for patients with complete rectal prolapse. Anterior resection withstands long-term scrutiny both in terms of recurrence rate and associated complications.
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PMID:Anterior resection for the treatment of rectal prolapse: a 20-year experience. 848 90

For three years we studied the mortality and functional situation of all patients admitted in 1991 to the Neurology Service suffering from acute stroke with the exception of subarachnoid haemorrhage cases. We analyzed the cause of death whether directly related to the initial illness or not. Out of 134 patients admitted for acute stroke, 48 (41.02% of the 117 patients examined after excluding 17 whom we did not obtain complete information from) had died after three years. The main causes of death were directly related to acute stroke (37.5%) and pneumonia (37.5%). Death occurred mainly in the first month (79.16% of deaths). Predictive variables for mortality directly related to acute stroke during the first month include severe weakness, brain haemorrhage, dysphasia and earlier incidence of acute stroke. Variables related to higher mortality rate due to other causes in the first month were dysphasia, age and angina antecedents, whereas earlier incidence of acute stroke was associated with a lesser mortality rate for these causes, as distinct from acute stroke itself. Greater levels of weakness and sphincteral incontinence are the best predictive signs of dependency functional situation at the end of the first month and, along with diabetes, after one and three years.
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PMID:[3 year survival in patients hospitalized for acute cerebrovascular disorders]. 871 89

Urinary incontinence (UI) after stroke is common and associated with overall poor functional outcomes. There is controversy regarding which factors contribute to incontinence after stroke and which factors may be predictive of recovery of continence. This study investigated consecutive stroke admissions to an inpatient rehabilitation hospital and evaluated the impact of several pre-selected factors on the presence of UI and its recovery. We also studied the impact of UI on outcome in terms of functional abilities with the Functional Independence Measure (FIM) and in terms of disposition. UI on admission was associated with severe functional impairment with large infarctions and was probably caused by general severity rather than specific impairment of neuromicturition control. Patients with less impairment (admission FIM > 60) and small vessel strokes were likely to recover continence. UI on admission had a negative impact on outcome.
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PMID:Incontinence after stroke in a rehabilitation setting: outcome associations and predictive factors. 879 60

To estimate the prevalence and risk factors of urinary and fecal incontinence and examine its prognosis among a community-residing elderly population, a randomly selected sample of 1473 elderly people, aged 65 years and over, living in the City of Settsu, Osaka, was investigated in October 1992. Data was obtained from 1405 for a response rate of 95.4%. The cohort of 1405 was followed for 38 months and follow-up was completed for 1325 (94.3%). The main results were as follows: 1) The prevalence of urinary incontinence of any degree was 9.8% in both sexes, and 8.7% men and 6.6% women admitted to some degree of fecal incontinence. 3.4% and 2.0% of the elderly were daily incontinent in urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes. 2) By univariate analyses, age older than 75 years, low activities of daily living (ADL), stroke, dementia, no participation in social activities, and lack of a perception of having a life worth living were significantly associated with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years and low ADL were significantly associated with any type of incontinence. Stroke was associated with incontinence less than once a day, while dementia was associated with incontinence more than once a day. 3) From analysis by Kaplan-Meier method and log-rank test, the estimated survival rates were higher among the elderly without incontinence than among those with incontinence, and tended to become low with the increased frequency of incontinence in both urine and feces. 4) From Cox proportional hazards model analysis, less than once daily fecal incontinence and once or more fecal and urinary incontinence daily remained as statistically significant factors associated with survival, controlling for other factors.
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PMID:[Urinary and fecal incontinence in a community-residing elderly population: prevalence, correlates and prognosis]. 917 10


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