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

Diabetes in the elderly is a growing public health burden. Persons with diabetes are living longer and are vulnerable to the traditional microvascular and macrovascular complications of diabetes but also at increased risk for geriatric syndromes. Peripheral vascular disease, heart disease, and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status. Older adults with diabetes are also more likely to experience geriatric syndromes such as falls, dementia, depression, and incontinence. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of adverse complications from diabetes.
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PMID:Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. 2401 32

Symptomatic hydrocephalus in association with basilar artery ectasia is a rare occurrence. We report an 81-year-old woman with progressive dementia, gait disturbance, and sphincter incontinence. Brain computed tomography (CT) and magnetic resonance imaging (MRI) scans showed obstructive hydrocephalus with compression of the fourth ventricle by a large ectatic basilar artery. After ventriculoperitoneal shunting, the patient showed rapid resolution of symptoms. This case illustrates that ventricular obstruction due to basilar artery ectasia can mimic the classical triad of normal pressure hydrocephalus.
J Stroke Cerebrovasc Dis
PMID:Vertebrobasilar artery ectasia presenting as hydrocephalus. 2419 27

Paucity of studies on the prognosis of ischaemic stroke prompted this study. Sixty-seven patients with CT-proven infarction were studied after a mean duration of 9 days to evaluate the role of a number of clinical, CT scan and evoked potential parameters in predicting the prognosis. Their mean age was 53 (range 22-82) years and 16 were females. Four of these patients died and 20 had poor recovery. Out of 24 clinical, CT scan and evoked potential parameters analysed by univariate analysis, 11 variables were found to be significant These were Canadian Neurological Scale, Glasgow Coma Scale (GCS), Motoricity Index, muscle tone, tendon reflex, incontinence, sensations, motor area involvement on CT scan, size of infarction, motor evoked potential and somatosensory evoked potential. Multivariate logistic regression analysis was employed to study the combined effect of different variables on the outcome. The best model included past history of stroke, GCS, pulse pressure and involvement of motor area on CT scan. The model proposed by us is simple and useful for predicting 3 month outcome of ischaemic stroke. A larger study is recommended to confirm these findings.-
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PMID:Prognosis of ischaemic stroke - a multivariate analysis. 2428 79

This is the first prospective study evaluating both urinary complaints and bladder physiology following acute cerebrovascular accidents (CVAs). Consecutive patients with acute CVAs were entered into this study. Voiding histories and urodynamics were performed 1-2 weeks post-CVA, 1-2 months post-CVA, 4-10 months post-CVA, and 5 months later (9-15 months post-CVA). Previous studies have focused on urinary incontinence and reported that this problem resolves in the majority of patients. This study also found that urinary incontinence resolved. However, other urinary complaints, such as urinary frequency and nocturia, which also had a significant adverse impact on the individuals' lifestyle, continued to persist. Urodynamic studies at one year revealed that uninhibited bladder contractions persisted despite resolution of incontinence. There was no obvious relationship between the location of the CVA in the right hemisphere and those who did or did not develop urologic symptoms.
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PMID:Voiding Symptoms and Bladder Function Following CVA: A Prospective Time Course Study. 2452 13

An 84-year-old diabetic women receiving in-hospital stroke management began suffering from vague lower abdominal pain, increased urge incontinence and gross hematuria. Physical examination revealed suprapubic tenderness and a tympanic bladder. A computed tomography confirmed a distended bladder with gas foci delineating the bladder wall. Microbiology revealed an atypical multi-organism presentation of Klebsiella pneumoniae and Enterococcus species. Emphysematous cystitis is characterized by air within the bladder wall often found in elderly diabetic females. Predominant organisms include Escherichia coli and Klebsiella pneumonia. Prompt treatment is essential in this potentially fatal condition.
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PMID:Emphysematous cystitis: An atypical multi-organism presentation. 2608 93

Many emotional disturbances such as post-stroke depression (PSD) and emotional incontinence (EI) commonly occur following cerebrovascular events. The efficacy of antidepressants for these conditions has been established but their comorbid treatment has not been well characterized. In the current study, the authors describe two cases of post-stroke emotional dysregulation; one case with EI; and the other with EI complicated by PSD. The authors describe their differential responses to treatment. Case 1 developed EI after an infarct due to occlusion of the penetrating branches of the left middle cerebral artery (MCA). Case 2 developed both PSD and EI after right MCA stem occlusion. Both patients were initially treated with the selective serotonin reuptake inhibitor (SSRI) paroxetine. Case 1 reacted promptly to SSRI treatment. However, Case 2 had only a partial response to paroxetine, even after many months of treatment. Adjunctive therapy with low-dose aripiprazole was eventually added, resulting in complete improvement of both EI and PSD after 2 additional months of treatment. Thus, Case 2 required a different treatment strategy than Case 1. These findings suggest that aripiprazole adjunctive therapy could be effective for some complex post-stroke emotional disorders.
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PMID:Two cases of emotional disorder after middle cerebral artery infarction showing distinct responses to antidepressant treatment. 2492 98

The primary purpose of this study was to examine the effects of an intervention consisting of the four translation strategies of educational materials, educational meetings, reminders, and audit and feedback on nurses' adoption of an evidence-based bladder program for patients with stroke in an acute care setting. The secondary purpose was to evaluate the difference in incontinence episodes of patients with stroke before and after nurses received the intervention. Finally, the purpose was to evaluate the influence of nurses' attitudes and the demographic characteristics on the adoption and use of the evidence-based bladder program after receiving the intervention. This study was the first to provide empirical support for the influence of the combination of these four translation strategies and nurses' attitudes toward research on the adoption of evidence-based practice in a time-series design study. Thus, the combined use of the four translation strategies did have an impact on nurses' adoption of evidence-based practice.
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PMID:The effectiveness of four translation strategies on nurses' adoption of an evidence-based bladder protocol. 2499 47

Post stroke infections are a significant clinical problem. Dysphagia occurs in approximately half of stroke patients and is associated with respiratory infections; however it is unclear what other factors contribute to an increased risk. This study aimed to determine which factors are most strongly predictive of infections in the first 7 days post stroke admission. A retrospective review of 536 stroke patients admitted to Australian hospitals in 2010 was conducted. Data were collected on 37 clinical and demographic parameters. Univariate and multivariate logistic regression analysis was performed. The overall incidence of infection was 21%. Full assistance with mobility and incontinence on admission were associated with increased odds of general infection. Nil by mouth and presence of a nasogastric tube were significantly associated with patients developing respiratory infections. Urinary incontinence was a significant predictor for a urinary tract infection. Incidence of infection was highest on day two post admission. This study found enteral feeding, requiring full assistance with mobility and incontinence were significantly associated with developing infections in acute stroke. It contributes valuable new data from a large cohort of stroke patients demonstrating a period of susceptibility to infection in the very acute post stroke period.
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PMID:Can't swallow, can't transfer, can't toilet: factors predicting infections in the first week post stroke. 2517 63

Post-stroke depression (PSD) and post-stroke emotional incontinence (PSEI) have attracted worldwide interest in recent years. These emotional disturbances have a negative impact on the rehabilitation process and the associated worse outcome. Consequently, defining the risk factors for development of PSD and PSEI is important. In this study, we evaluated 368 consecutive patients with acute ischemic stroke at admission and at three months later. PSD was evaluated by using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Multivariate analyses showed that anterior cortex infarction was associated with PSEI three months after stroke occurrence. The appearance of PSD was not related to lesion location. Both motor and sensory dysfunctions was independently associated with PSD at admission, whereas low degree of social utilization was the independent factor associated with PSD 3 months after stroke. Acceptance-resignation is related to PSD and PSEI both at admission and 3 months after stroke. Avoidance was the independent factor related to PSD at 3 months after stroke onset.
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PMID:Factors associated with post-stroke depression and emotional incontinence: lesion location and coping styles. 2953 6

Neuroleptic malignant syndrome (NMS) is associated with the administration of antipsychotic agents and other drugs such as l-dopa, antidepressants, and antihistaminic agents. Unexpected changes in mental status, new-onset catatonia, episodic tachycardia, tachypnea, hypertension, dysarthria, dysphagia, diaphoresis, sialorrhea, incontinence, low-grade temperature elevations, and rigidity should arouse suspicion. Several lines of evidence provide support for the involvement of dopamine. Most of the drugs implicated in NMS are D2 dopamine receptor antagonists. Central noradrenergic activity is also possibly related to the disorder, as sympathetic hyperactivity is associated with the active phase of NMS. Currently, the definitive role of GABA deficiency in NMS is yet to be established. Differential diagnosis should include malignant hyperthermia, lethal catatonia, lithium toxicity, serotonin syndrome, and heat stroke. A high degree of suspicion and the discontinuation of antipsychotic agents even if the diagnosis is not established are essential for the safety of the patient. Treatment of NMS should be individualized and be based empirically on the character, duration, and severity of the clinical signs and symptoms noted. The initial step in the treatment of NMS is the removal of the offending agent. Full-blown NMS is a serious condition and requires immediate supportive, nutritive, and electrolyte therapies. The administration of drugs that can improve NMS, such as IV dantrolene and/or oral bromocriptine, may also be taken into consideration, based on the severity and nature of the NMS.
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PMID:Neuroleptic malignant syndrome: risk factors, pathophysiology, and treatment. 2698 10


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