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

This study assessed the validity of the Balance Scale by examining: how Scale scores related to clinical judgements and self-perceptions of balance, laboratory measures of postural sway and external criteria reflecting balancing ability; if scores could predict falls in the elderly; and how they related to motor and functional performance in stroke patients. Elderly residents (N = 113) were assessed for functional performance and balance regularly over a nine-month period. Occurrence of falls was monitored for a year. Acute stroke patients (N = 70) were periodically rated for functional independence, motor performance and balance for over three months. Thirty-one elderly subjects were assessed by clinical and laboratory indicators reflecting balancing ability. The Scale correlated moderately with caregiver ratings, self-ratings and laboratory measures of sway. Differences in mean Scale scores were consistent with the use of mobility aids by elderly residents and differentiated stroke patients by location of follow-up. Balance scores predicted the occurrence of multiple falls among elderly residents and were strongly correlated with functional and motor performance in stroke patients.
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PMID:Measuring balance in the elderly: validation of an instrument. 146 55

With an increasing understanding of the pathophysiology of human brain ischemia, it appears that time is of critical essence in the diagnosis and management of the acute stroke victim. A review of the acute ischemic stroke patient in an intensive care setting is described. Recent knowledge of clinical stroke assessment is summarized, with further emphasis on in-hospital strokes. Acute stroke units are described with a focus on the general clinical approach to patients with acute cerebral ischemia: investigations, recent treatment advances, and rehabilitation. Unless patients with acute brain ischemia are given the opportunity for aggressive management, care, and enrollment into promising therapeutic protocols, ideally within an acute stroke unit setting, the tremendous burden of stroke will not be lifted.
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PMID:Acute cerebral ischemia in a critical care unit. A review of diagnosis and management. 264 19

Eleven of 31 clinical centers participating in the Italian Acute Stroke Study--Hemodilution carried out a preliminary study on the effectiveness of ganglioside GM1 in acute stroke; 502 patients were randomized to GM1 (GM1, n = 121), GM1 plus hemodilution (GM1 + H, n = 128), placebo (P, n = 130), or placebo plus hemodilution (P + H, n = 123) groups less than or equal to 12 hours after onset of a hemispheric cerebral infarct. The patients were treated for 15 days and were evaluated on Days 21 and 120 after the onset of stroke. Intention-to-treat analysis failed to show any differences in neurologic deficit, mortality, or neurologic disability among the groups. Efficacy analysis showed a significantly higher degree of neurologic improvement in GM1 group patients compared with patients in the P group during the first 15 days. GM1-treated patients (GM1 and GM1 + H groups) showed a significantly higher degree of neurologic improvement during the first 10 days compared with the placebo-treated patients (P and P + H groups). These differences were no longer statistically significant at Day 120. Our results provide a rationale for the planning of a larger, multicenter trial of GM1 ganglioside in acute stroke.
Stroke 1989 Sep
PMID:GM1 ganglioside therapy in acute ischemic stroke. Italian Acute Stroke Study--Hemodilution + Drug. 233 64

In a 74-year old female, admitted to the Acute Stroke Unit for a cerebral reversible ischemic attack, we investigated the occurrence of ischemic alterations on ECG, recorded during an acute relapse, using 99mTc (MIBI) myocardial scintigraphy. Scintigrams showed a transient anteroseptal and inferior hypoperfusion. This is the first direct demonstration of myocardial ischemia occurring during stroke.
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PMID:Myocardial ischemia during stroke: scintigraphic demonstration. 275 48

The Italian Acute Stroke Study is a prospective, multicenter, randomized, clinical trial to evaluate hemodilution in acute stroke. Thirty-one centers will recruit 1,200 patients with a recent (less than 12 hours) hemispheric acute stroke. Randomization is performed centrally, and patients are stratified by center and severity of neurologic deficit. Hemodilution is achieved by venesection and infusion of the same amount of dextran 40. Otherwise, both treated and control groups receive the standard treatment provided by each center within agreed guidelines. At 6 months after stroke, one member of the Clinical Coordinating Center, blind as to treatment allocation, collects data on mortality and disability by telephone. We expect to terminate the randomization on December 31, 1986, and the follow-up evaluation on June 30, 1987. The aim of the study is to evaluate whether mortality and disability are significantly reduced in the group treated with hemodilution compared with the control group.
Stroke
PMID:The Italian hemodilution trial in acute stroke. Italian Acute Stroke Study Group. 288 59

The possibility that acute stroke produces an increase in sympathetic tone with resultant cardiac abnormalities was examined in 100 stroke patients admitted to a stroke ICU and in 50 controls found to have diagnoses other than stroke or TIA after admission to the Unit. Continuous 24 hour Holter ECG tapings were performed and serum cardiac enzymes and plasma norepinephrine concentrations were measured within 48 hours after admission. Significantly, (p less than .001) more serious arrhythmias were observed during 24 hour Holter ECG monitoring in stroke patients compared with controls and the difference remained (p less than .01) after matching for age and co-existing heart disease. Arrhythmias were more common in older stroke (p less than .001) and older control (p = .05) patients and with infarction of the cerebral hemispheres (p less than .05) as compared to brainstem lesions. Arrhythmia occurrence was independent of the presence of co-existing heart disease and the level of sympathetic activity. However, the 15 stroke patients with abnormally high CK values (mean 34.3 units) had a higher (p less than .02) mean plasma norepinephrine concentration (650.4 pg/ml) than stroke patients with normal CK (427.7 pg/ml). Acute stroke may cause cardiac arrhythmias and myocardial cell damage, the latter through stroke induced increases in sympathetic tone.
Stroke
PMID:Cardiac sequelae of acute stroke. 714 1

Rapid identification of stroke subtype is valuable for both practicing clinicians and the optimal design of clinical stroke trials. Mechanisms of ischemic injury might differ among different stroke subtypes. Certain subtypes might be clinically identified as suboptimal for future therapeutic or prophylactic stroke trials. Some subtypes might be so clinically distinct that extensive laboratory investigation is unwarranted. Investigators in the ongoing Trial of ORG 10172 in Acute Stroke Treatment are using criteria to categorize stroke etiology among enrolled patients into one of five subtypes: large-artery atherothromboembolic, cardioembolic, small-vessel thrombotic, other etiology, or undetermined etiology. As part of the study, physicians initially predict the most likely subtype of stroke based on clinical features and baseline CT. Three months after stroke, investigators use the criteria, which also incorporate results of diagnostic testing, to reclassify stroke subtype. Initial clinical impression of subtype agreed with final determination in 62% of patients, and the rate was similar for all stroke subtypes. No stroke subtype was more accurately diagnosed than others by initial assessment. No subtype was more commonly identified by diagnostic studies. Fifteen percent of patients remained without a clear etiologic subtype diagnosis at 3 months. We conclude that clinical trials in stroke should not attempt to restrict entry into trials based on presumed stroke subtype. A careful evaluation for etiology is justified in all patients presenting with stroke, regardless of presumed subtype.
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PMID:Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment. 750 Nov 44

In September 1993 arrangements for managing acute stroke victims in South Ayrshire changed with the opening of a six bedded Acute Stroke Unit and a fifteen bedded Rehabilitation Stroke Unit. Previously all such patients were managed within general medical wards with a few being managed in geriatric assessment and rehabilitation facilities. This study compares the management and outcome from acute stroke before and after the establishment of these new Units. Fifty-eight patients' medical, nursing and paramedical records were studied for the period of investigation in 1992 and 68 for the same period in 1993. There was no significant difference in the age of the patients admitted or in the degree of neurological or functional impairment at the time of admission. There was a reduction in mortality from 37.9% in 1992 to 22.0% in 1993. This was not accomplished by an increase in the number of survivors requiring long term institutional care and there was no significant difference in the degree neurological or functional impairment at the time of discharge. A variety of specific management issues were also addressed by the study and in all areas there were improvements in the quality of care received by this group of patients in 1993. This study supports the view that management of acute stroke victims in specifically designated Stroke Units has a beneficial effect on outcome and quality of care.
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PMID:Acute stroke in South Ayrshire: comparative study of pre and post stroke units. 761 87

Studies in laboratory animals indicate that certain centrally acting drugs (eg, the antihypertensives clonidine and prazosin, neuroleptics and other dopamine receptor antagonists, benzodiazepines, and the anticonvulsants phenytoin and phenobarbital) impair behavioral recovery after focal brain injury. Even single doses may have long-term harmful effects. To determine whether these medications have a similar negative impact in humans, we analyzed the recoveries of control patients who were enrolled in the Sygen in Acute Stroke Study, a multicenter study of the effects of GM1 ganglioside after ischemic stroke. Motor impairments were measured by the motor subscores of the Toronto Stroke Scale at baseline and 7, 14, 21, 28, 56, and 84 days after stroke. Using these data, we compared motor recovery between patients with initial motor deficits who received at least one of the drugs that interfere with recovery in laboratory studies ("detrimental" drug group, n = 37) and patients who did not receive these drugs ("neutral" drug group, n = 59). The groups were well balanced with regard to the frequency of comorbid conditions and other prognostic factors. For upper-extremity motor function, repeated-measures ANOVA showed a significant interaction between drug group and time after stroke [F(6,528) = 2.38; p = 0.03], with a significant (p < 0.001) difference between the groups beginning 7 days after the stroke. A similar trend was present for the lower extremity, but the overall difference between the groups was not significant [ANOVA F(6,498) = 1.22; p = 0.29]. Drug group did influence the degree of independence in activities of daily living as measured with the Barthel Index.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Common drugs may influence motor recovery after stroke. The Sygen In Acute Stroke Study Investigators. 878 Jan 29

Acute stroke may cause hypertension and actually available devices for non-invasive blood pressure monitoring make it possible to study short-term variability of pressure in this condition, in order to settle a more rational diagnostic and therapeutic approach. In our experience blood pressure variability has shown to be greater in thrombo-embolic, than haemorrhagic stroke. This outcome contributes to explain literature disagreement on benefits of antihypertensive therapy and suggests the need for blood pressure monitoring in every trial, that wants to evaluate with satisfactory reliability the antihypertensive treatment in ischaemic stroke. As to antihypertensive drugs to be used in stroke patients, we prefer antiadrenergics, because hypertension in this clinical condition is due to adrenergic overactivity. Our preliminary experience with a centrally acting antiadrenergic drug (clonidine) has shown its ability not only to reduce blood pressure, but also blood pressure variability in ischaemic stroke.
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PMID:[Therapy of arterial hypertension associated with acute stroke. Current trends and problems]. 788 23


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