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

The aim of this prospective study was to investigate the value of CT scan in prognosis of acute ischaemic stroke patients as a variable additional to clinical stroke syndromes to develop a simple classification of CT scan features to provide a practical approach to prognosticate and manage such patients. One hundred and eight nine patients admitted with ischaemic stroke were investigated with a CT scan. CT scan features were classified into two groups: large infarct, LI (across more than one lobe) and non-large infarcts (N-LI) for all other features. Patients were also studied for clinical syndromes, analysing results for total anterior circulation syndrome (TACS). Outcome was measured as early post stroke Barthel index, acute phase and 3-month mortality. Patients with LI had features of severe strokes and had a lower Barthel index (p < 0.001), lower Glasgow coma score (p < 0.001), more association with incontinence (p < 0.001), pyrexia (p = 0.007) and dysphagia (p < 0.001). LI patients required higher level of care in acute wards and had a higher length of stay (p = 0.01). Both the LI and TACS individually had a significantly higher mortality (p < 0.001) and similar positive predictive value, sensitivity and specificity for 3-month mortality. While the combined factor of 'large infarct and TACS' provided the highest likelihood ratio (3.1) for mortality, the factor of 'large infarct or TACS' was the most sensitive (85%) to identify majority of patients at a risk of mortality. N-LI patients had a better prognosis. Classification of cerebral infarcts into large and non-large categories identifies patients who require higher level of care in acute wards and have a higher mortality. Combined factor of 'large infarct and/or TACS' identifies the majority of patients at risk of 3-month mortality as compared to either variable taken individually. CT scan features are complimentary to clinical syndromes for managing acute stroke patients.
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PMID:Prognostic value of CT scan features in acute ischaemic stroke and relationship with clinical stroke syndromes. 1119 29

In measuring the progression of, or recovery from, a disease an individual's outcome may be assessed on a number of occasions. A model of the relationship between outcome and time since disease occurred which accounts for patient characteristics could be used to describe patterns of recovery, to predict outcome for a patient, or to evaluate health interventions. We use multilevel models to analyse such data, focusing on the choice of powers of time both for mean outcome and covariate effects. We give equations for predicted outcome and corresponding standard errors (i) based only on baseline characteristics, and (ii) by conditioning on previous outcomes for an individual. In a study of 331 stroke patients, outcome was measured approximately 0, 2,4,6 and 12 months after stroke. Patient characteristics included age, sex, and pre-stroke handicap, together with stroke-severity indicators (presence of limb deficit, dysphasia, dysarthria or incontinence). Of these, only the effects of age, dysphasia and presence of deficit varied with time. Conditioning on previous observations improved the accuracy of predictions. The outcome variable clearly had a skewed distribution, and the model residuals showed evidence of non-Normality. We discuss alternative models for non-Normal data, and show that, here, the standard (Normal errors) multilevel model gives equivalent parameter estimates and predictions to those obtained from alternative models.
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PMID:Multilevel growth curve models with covariate effects: application to recovery after stroke. 1124 71

The objective of this study was to develop a simplified scoring system to predict 30-day mortality in patients with acute ischemic stroke. A retrospective cohort study was performed in a tertiary referral hospital in the Hunter Region of Australia. A prognostic index was created by assigning points to the variables in a Cox model. The index included impaired consciousness (5 points), dysphagia (3 points), urinary incontinence (4 points), admission body temperature higher than 36.5 degrees C (2 points), and hyperglycemia without a clinical history of diabetes (2 points). A score of 11 or more defined a high-risk group. The index achieved a sensitivity, specificity, and positive predictive value of 68%, 98% and 75%, respectively, in the derivation sample and 57%, 97% and 68%, respectively, in the validation sample. The results provide a simple risk stratification instrument for clinical research and practice. Further evaluation of the model in a prospective cohort is warranted
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PMID:A prognostic index for 30-day mortality after stroke. 1250 82

The classic literature on pathological laughter and crying emphasizes the difference between incontinence and lability of affect. Pathological laughter and crying as key symptoms of affect incontinence are viewed as the effects of disinhibition of motor synergisms without congruent affect, which is the crucial difference to affect lability. The interpretation as a disinhibitory phenomenon is supported by clinical and electromyographic observations, which found a lack of modulation of intensity in pathological laughter and crying. In 1924, Wilson postulated a supranuclear pontobulbar center for affective synergisms that is controlled by cortex and thalamus. Accordingly, Kleist viewed a combined lesion of thalamic or brainstem structures and corticofugal motor projection systems as the pathoanatomic basis of affect incontinence. Recent work reported the frequent occurrence of affect incontinence with stroke and dementia of the Alzheimer type and thus disagrees with the classical theory. However, the methods used cannot rule out a confounding between affect lability and incontinence.
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PMID:[Pathological laughing and crying]. 1158 84

The three well-known criteria for legal competence and testamentary capacity, that is: consideration, awareness and the ability to express oneself in writing and speaking, ought to be extended by three further dimensions, namely: motivation, long-term intentions, gestures. This demands increased specialised competence and increased time, but seems indispensable in order to meet the postulate of human ethics: to give the patient the optimum support for a sensible realisation of will. This equally applies to medical experts and jurists (especially notaries and lawyers). The related demand to give increased time and attention to a patient, often in the form of repeated observation over several days, with detailed written documentation, shows that it is not at all a weakening, which is supported, but rather a more precise formation of concept. In this sense, we expect to meet better the demand of the best possible "objectivity" in evaluation, rather than within a merely schematic, single, short-time assessment. We substantiate this with several examples, taken from various areas, namely: in isolated aphasic/agraphic disorders, testamentary capacity and even legal competence can be retained according to the above criteria (despite the inability to write and speak). In analogy, also "last minute" decisions of the incurably sick person must be taken into account. We also show, however, that an assertion of legal competence (unrestricted ability to reach a decision) based on merely formalistic guide-lines, without taking into account long-term intentions and motivation, might seriously harm a patient. There is the case of a post-apoplexy patient who demanded immediate discharge to return home. This patient proved fully aware in classical questions of reference, but, due to homesickness, post-apoplectic syndrome and senile stubbornness, failed to take into account her inability to walk and incontinence. A consolidated discharge, however, was very well possible several weeks later. At an earlier stage this would have led to disaster. There will always remain a zone in which it is not possible to reach clear expert decisions either pro or contra but by incorporating the criteria above quoted, it will be possible to considerably narrow this zone. This corresponds to an evaluation process, which cultivates both optimum objectivity and optimum fairness.
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PMID:[Expanded criteria for assessment of legal competence and testifying capacity in borderline cases of organic brain syndromes--an important field for cooperation between medicine and law]. 1160 10

Evidence of the benefit of exercise for patients with musculoskeletal problems was examined by analysing meta-analyses and systematic reviews. The literature search was confined to studies where pain and/or function was used as the outcome measure. Twenty-three meta-analyses/systematic reviews were covered, and the methodical quality was assessed. Nine out of twelve meta-analyses showed that exercise had a positive effect on groups groups diagnosed with intermittent claudication, fibromyalgia, incontinence, low back pain, and stroke, whereas one meta-analysis (exercise to prevent falls in the elderly) showed no effect. Of the systematic reviews, six out of 12 showed a positive effect and five were inconclusive, owing to the lack of clinical trials. We conclude that much more research in the field of exercise and physiotherapy is needed.
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PMID:[Evidence-based grounds of physical therapy. Focus on training/exercise therapy of musculoskeletal problems]. 1181 Jul 92

Urinary incontinence is a common problem among the elderly, especially those admitted to acute care hospitals. A study investigating this problem was conduced in the geriatric wards of the Tuen Mun Hospital, Tuen Mun, from 26 October 1995 to 9 November 1995. Fifty of 139 (36%) patients had urinary incontinence with a male to female ratio of 1:15. Patients with urinary incontinence were found more often to have mobility problems and a higher institutionalisation rate than did continent patients. Dementia and cerebrovascular accident were also found to be associated with this problem. Although it is a common problem, none had been evaluated or treated before. Most of the caregivers thought that urinary incontinence was a normal ageing process and used diapers to treat this problem.
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PMID:Urinary incontinence: an ignored problem in elderly patients. 1184 53

Ageing of the Hong Kong population is associated with an increased prevalence of physical and mental disability. For persons with severe disability, infirmary care is needed. In the present study, the morbidity pattern of persons waiting for infirmary service in Hong Kong was studied. Two hundred and four consecutive Central Infirmary Waiting List persons were included in the study. Clinical assessment was based on history review and physical examination. The commonest diagnoses giving rise to severe disability in this population, 89.2% of whom were elderly (aged greater-than-or-equal65 years), in descending order of prevalence were stroke (40.2%), dementia (27.0%), proximal femoral fracture (7.4%), and parkinsonism (5.9%); 67.5% of subjects were dependent physically. For cognitive function, 87.3% had a subnormal Abbreviated Mental Test score of less-than-or-equal5. Approximately 80% had urinary incontinence and/or bowel incontinence. For the outcome of assessment, 93.6% needed infirmary care, while 6.4% did not. More adequate provision of infirmary beds, innovative medical, nursing, and social home-support programmes, and effective prevention and rehabilitation programmes for patients with these disabling diseases are urgently needed in Hong Kong.
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PMID:Morbidity patterns of persons waiting for infirmary care in Hong Kong. 1184 86

Using the 10-item Spielberger Trait Anger Scale, the authors interviewed 145 patients with stroke regarding inability to control anger or aggression (ICAA). Poststroke depression and emotional incontinence were also assessed. ICAA was present in 47 patients (32%) and was closely related to motor dysfunction, dysarthria, emotional incontinence, and lesions affecting frontal-lenticulocapsular-pontine base areas. ICAA seems to be one of the major behavioral symptoms in patients with stroke.
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PMID:Inability to control anger or aggression after stroke. 1194 Jul 3

There is increasing evidence that environmental and neuropharmacologic treatments enhance stroke recovery. Functional magnetic resonance imaging and transcranial magnetic stimulation have significantly broadened our understanding of the neuroanatomic relationships involved in recovery from brain injury due to stroke. These tools have also demonstrated the role for pharmacologic enhancement of cortical plasticity coupled with behavioral interventions. Robot-assisted therapy and partial body weight-supported treadmill gait training have demonstrated the role for technologic intervention in the modern neuro-rehabilitation setting. Current research using hemi-field ocular prisms and patching techniques suggest a role in the rehabilitation of hemianopsia and visual neglect. Finally, many advances have been made in the understanding of common stroke complications, such as depression, dysphagia, venous thromboembolic disease, incontinence, and spasticity.
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PMID:New developments in stroke rehabilitation. 1205 78


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