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

Urinary incontinence can occur poststroke owing to weakness or incoordination of sphincter muscles, impaired bladder sensation, or hyperreflexic, neurogenic bladder. Four male subjects who had urinary incontinence associated with a stroke that had occurred 8 months to 10 years earlier, and who averaged 1.6 to 7.5 accidental voidings per week, participated in an outpatient study with a 4-week scheduled-voiding baseline, 2 to 5 sessions of biofeedback-assisted bladder retraining, and 6- to 12-month follow-up. Training sessions included stepwise filling of the bladder and manometric feedback display of bladder pressure, abdominal pressure, and external anal sphincter pressure. Training procedures were designed to teach subjects to attend to bladder sensations, inhibit bladder contractions, and improve voluntary sphincter muscle control. All four subjects achieved and maintained continence regardless of substantial differences in subject characteristics, including laterality of stroke, degree of sensory impairment, and independence in daily activities.
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PMID:Biofeedback in treatment of urinary incontinence in stroke patients. 275 58

Natural-history data from 362 conscious stroke victims, taking part in an acute intervention trial, were used to explore the prevalence and time course of recovery of urinary incontinence, associations with other variables and the relationship between bladder control and neurological, functional and overall outcome. More than half the patients were incontinent when first seen, at a mean of 24 h after onset, but this proportion fell to 29% by 1 month and was halved again by 6 months. Outcome was so much better in those who remained or became dry that it seems possible that recovery of continence may promote morale and self-esteem which could actually hasten overall recovery. A controlled trial of a rehabilitation programme, concentrating on restoration of bladder control in the early stages of stroke, is now needed to test this possibility.
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PMID:Continence after stroke: useful predictor or goal of therapy? 278 16

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

Actual functional performance of 976 acute stroke patients was assessed using the Barthel index: the data were analysed to determine the frequency of disability after stroke, the validity of the Barthel index, and the recovery seen. At 6 months, over 45% of survivors were functionally independent. Validity of the Barthel index was confirmed: it related as expected with motor loss and factor analysis showed a single major factor. The items of the Barthel index form an hierarchical scale. There was some recovery between 3 weeks and 6 months in almost all patients: the major prognostic factors were urinary incontinence, functional ability, sitting balance and age.
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PMID:Functional abilities after stroke: measurement, natural history and prognosis. 357 32

About 20% of the survivors from acute stroke are relocated from a general hospital to a rehabilitation centre or to a nursing and reactivation home. This occurs about one or two months after the stroke. At that point in time the most important period for spontaneous recovery has already passed. In 1981 a recent stroke was the somatic reason for admission in 21.4% of all patients in nursing-homes. In comparison to rehabilitation centres more elderly stroke patients with many other disorders are admitted to nursing-homes. It is also shown that the more disabled stroke patients are admitted to nursing-homes, but this appears to be influenced by the presence of a rehabilitation centre in the area. Urinary incontinence, a 'psychosyndrome', a relapse of stroke, a healthy partner and, to a lesser degree, aphasia determine the perspectives for discharge, besides functional recovery. But also the care setting and the facilities of a day hospital in a nursing-home are important factors that will influence the prognosis for discharge.
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PMID:[Role of the nursing home in the after care of CVA patients]. 359 Feb 80

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

During one year 151 patients with 154 strokes were studied prospectively to determine the occurrence and outcome of urinary incontinence after a stroke. Seventeen per cent had pre-existing urinary incontinence. At 1, 4 and 12 weeks, 60%, 42% and 29% of the survivors, respectively, were not continent. Cystometry was performed in those with moderate or severe urinary incontinence persisting 4 weeks after the stroke. Detrusor instability was present in 85% of those who had been continent prior to their stroke. Factors associated with urinary incontinence at 4 weeks were moderate or severe motor deficit, impaired mobility and mental impairment (P less than 0.001). Two-thirds of patients with mild urinary incontinence at 4 weeks regained continence by 12 weeks.
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PMID:Urinary incontinence after stroke: a prospective study. 373 56

Ninety-nine patients had their function recorded regularly over the first 13 weeks after their stroke. Five functional areas were studied: urinary continence, mobility, the ability to dress, feeding, and the ability to transfer from bed to chair. Thirty-two patients died before 13 weeks. Forty-five of the 67 survivors had assessments twice weekly from within 4 days of their stroke. Recovery in these 45 patients occurred fastest in the first 2 weeks, by which time at least 50% of recovery had occurred, but it was still continuing at 13 weeks. Urinary incontinence present between 7 and 10 days after stroke was the most important adverse prognostic factor both for survival and for recovery of function. Age was the second most important factor. Hospital discharge seemed to occur once recovery had stopped, although four of the 49 patients discharged had been fully independent for at least 12 days prior to discharge. It is suggested that rehabilitative therapy should concentrate less on physical function and more on cognitive ability.
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PMID:Recovery after stroke--the first 3 months. 397 23


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