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

An hemodynamic study has been performed in eight patients (age 68 +/- 7) suffering from complete atrioventricular block. They had to undergo the definitive implantation of a cardiac pace maker under general anesthesia. The fixed cardiac frequency may help to understand the effect of the anesthetic agent used on the cardiac muscle function. Ketamine is the only agent used directly at an initial intravenous dose of 3 mg.kg-1 followed by a perfusion in a constant rate of 0.20 mg.kg-1. min-1. Hemodynamic data (arterial pressure, pulmonary pressures, thermodilution cardiac output) are performed before induction, then every 5 minutes after induction for a 20 minute period. The absence of respiratory depression (PaCO2: 38 +/- 3 mm Hg) shows that hemodynamic changes are entirely due to ketamine. The peak of these changes takes place after 5 minutes (significant rise (p < 0.05) in systemic and pulmonary resistances, in systemic arterial pressure and in pulmonary arterial pressure). Stroke index decreases moderately. After 20 minutes all the parameters have returned to control values. Use of ketamine is not desirable for two reasons: 1 degree The rise of the afterload may alter the hemodynamic state which can be previously deteriorated in patients suffering from atrio-ventricular block. 2 degree Post-anesthetic agitation can displace the right ventricular electrode.
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PMID:[Ketamine anesthesia for definitive implantation of a cardiac pace maker (author's transl)]. 55 78

A simple implanted device was used to occlude acutely the left middle cerebral artery (MCA) of 16 conscious cats. Eight received no treatment and 8 were given intravenous mannitol (1.2 gm/kg) at the time of occlusion. The initial neurological findings in both groups were similar, that is, agitation, forced circling, and right hemiparesis. The treated cats remained alert but the untreated cats became lethargic and drowsy. Perfusion with a mixture of colloidal carbon and buffered paraformaldehyde was carried out from 30 minutes to 6 hours following MCA occlusion. Results of morphological examination of brains from the treated and untreated groups suggested that mannitol had a protective effect upon cerebral tissue during the primary phase of acute focal ischemia. Light microscopic analysis of neuronal alterations demonstrated considerable preservation of neurons in brains of treated cats. Beneficial effect of mannitol was attributed partly to prevention of capillary narrowing and suppression of ischemic cerebral edema.
Stroke
PMID:Modification of acute focal ischemia by treatment with mannitol. 62 43

Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment.
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PMID:Pattern of use of antidepressants in long-term care facilities for the elderly. 141 68

A 64-year-old man developed hallucinations, delusions, and agitation after a right hemispheric cerebrovascular accident (CVA) in the occipital, inferior temporal, and parietal regions of the posterior cerebral artery. A review of the literature suggests that psychotic behavior is rare after CVA, but when such behavior does occur, the lesion is usually in the right hemisphere. Two clinical presentations are seen. One presentation involves patients free of chronic disease who develop episodic psychotic behavior at a time remote from their CVA. Electroencephalogram often demonstrates epileptogenic foci, and these patients often improve with anticonvulsant medication. Another presentation involves patients with one or more chronic diseases, often resulting in brain atrophy, who display continuous abnormal behavior soon after their CVA; these patients respond variably to antipsychotic agents.
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PMID:Psychotic behavior after right hemispheric cerebrovascular accident: a case report. 155 13

Agitation is a difficult problem to manage when patients suffer from cognitive impairment of varied etiology. In this article, the author proposes a combination of trazodone and tryptophan as a therapeutic possibility. The author presents an illustrative case. The patient was a 67 year old woman with a left cerebrovascular accident and a global aphasia who presented behaviour problems: she was restless, agitated, noisy, aggressive, screaming, howling and crying. In spite of treatment with neuroleptic, anxiolytic and antidepressive medication, behaviour did not improve. The use of a combination of trazodone and tryptophan was successful.
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PMID:[Pharmacotherapy to control agitation in patients with cognitive deficits]. 186 30

In a rehabilitation setting, pulmonary embolism is a relatively frequent and life-threatening complication. Deciding when a patient may be experiencing this condition is difficult, however, because of frequent deficits in patient communication skills (eg, aphasia and cognitive deficits) and the multisystem illnesses affecting many rehabilitation patients. We reviewed the charts of 30 rehabilitation patients transferred emergently during the years 1986 to 1988 with a diagnosis of pulmonary embolism, which was subsequently documented by ventilation-perfusion scanning. The average age of the 30 patients was 65; 63% were women and 20 (67%) had an admitting diagnosis of stroke. The most common new-onset clinical findings in the 24 hours before discharge were unusual facial skin color changes (pale, flushed, or cyanotic) (57%), chest or upper back pain (47%), tachycardia (heart rate more than 100 bpm) (40%), hypoxemia (arterial oxygen saturation less than or equal to 90%) (40%), and fever less than 101F (37%). In 63% of the patients, either anxiety, restlessness, diaphoresis, or dyspnea was also noted in the 24 hours before discharge. The data suggest that careful physician and nursing scrutiny may identify clinical signs characteristic of pulmonary embolism, and that the de novo appearance of these constellations of findings may help to select candidates for ventilation-perfusion scanning.
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PMID:Clinical findings associated with pulmonary embolism in a rehabilitation setting. 185 63

The purpose of this retrospective prediction study was to evaluate potential risk factors for falls in stroke patients in the acute care setting. Charts of 202 stroke patients who experienced falls and 111 stroke patients who did not fall (N = 313) were sampled from two major medical centers in the southwestern United States. Independent variables included: demographics; side of stroke; mental, motor and sensory status; activity level ordered; medications and laboratory values. A 16-variable multiple linear regression risk-factor equation resulted in r2 = .300, a highly predictive finding (F[16,296] = 7.92, p less than .001). Final results indicate that stroke patients with a history of falls, with impaired decision-making ability, that exhibit restlessness, generalized weakness, abnormal hematocrit and are easily fatigued should be identified for surveillance, especially at night when most falls occur.
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PMID:Predictive risk factors associated with stroke patient falls in acute care settings. 214 86

A major problem among hospitalized demented patients relates to the patients' agitation, resistance to nursing care, and loss of meaningful activity. The limited stimulus environment and restriction to a chair in an institutional environment contribute to such responses. Demented patients display significant interest in simple toys and stimulus objects. A variety of stimulus objects were provided; most interest was shown in mechanical toys devised for young children. In selecting toys and stimulus objects for patients, care must be taken to avoid objects that can be ingested, used as weapons, thrown on the floor where they will pose a safety hazard to ambulating residents, or that require constant intervention of nursing staff. Although patients greatly enjoy fabric and plush objects, they tend to hold or stroke them in a calm and passive manner. Mechanical objects stimulate vigorous exploration and use visual inspection, turning, spinning of dials, and manipulation of moveable or mechanical parts.
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PMID:The play project--use of stimulus objects with demented patients. 229 31

Thirty cancer patients scheduled for intra-arterial catheterization for chemotherapy were premedicated with pethidine 1 mg/kg atropine 0.807 mg/kg and prochlorperazine 5 mg intramuscularly. Anesthesia was induced with 2 mg/kg propofol and maintained with continuous infusion of propofol at a rate of 12 mg/kg/h. Patients breathed room-air spontaneously through the whole course of anesthesia. Anesthesia was induced with 2 mg/kg propofol in all patients, then maintained successfully by using a mean infusion rate of 12.13 +/- 0.43 mg/kg/h propofol. They lost consciousness within 29.60 +/- 5.50 second. Two minutes after induction, there were significantly decreased in systolic pressure, diastolic pressure, stroke volume and cardiac output but heart rate did not change significantly. Blood pressure and cardiac output remained stable but lower than pre-anesthetic values during the rest of the anesthetic course. Arterial blood gas analysis confirmed the respiratory depression. Two minutes after induction, there were significantly decreased in PaO2, SaO2 and pH were noted. PaCO2 was increased significantly. Recovery from the anesthesia was rapid and uneventful. The average time required for the patients to sustain eye-opening and to answer questions were 9.20 +/- 1.79 min and 10.73 +/- 1.87 min respectively after discontinuing propofol injection. Transient restlessness occurred in one patient. No other post-operative complications were noted.
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PMID:[Propofol intravenous anesthesia for intra-arterial catheterization in cancer patients]. 235 65

Primary care physicians have a vital role to play in identifying depression in their elderly patients. Diagnosis may be difficult, because symptoms are atypical and frequently include psychomotor agitation, somatic symptoms, and complaints of memory loss. Patients with medical illnesses, such as cancer, postmyocardial infarction, stroke, Parkinson's disease, and early Alzheimer's disease are particularly vulnerable to depression. Drugs that may cause depressive symptoms are digitalis at toxic levels, beta-blockers, centrally acting antihypertensives, immunosuppressants, and nonsteroidal anti-inflammatory agents. Cyclic antidepressants are the drugs of first choice. Selection depends on the patient's physical health and current medications and the side effect profile of the drug. Side effects are more pronounced in old age because of drug accumulation owing to slowed clearance. Troublesome side effects are anticholinergic effects, orthostatic hypotension, sedation, cardiotoxicity, and weight gain. The most useful antidepressants for geriatric patients are the secondary amines, desipramine and nortriptyline. The second-generation drug trazodone has the advantage of causing the least anticholinergic effects, but it is very sedating. Before treatment, the patient should have an electrocardiogram, liver function tests, tonometry, sitting and standing blood pressures, evaluation of urinary symptoms for outflow obstruction, review of current medications, and estimation of suicide risk. Cyclic antidepressants are contraindicated during recovery from myocardial infarction, in heart disease when there is severe impairment of myocardial performance, in seizure disorders, and in the presence of glaucoma or a large prostate. Drug interactions that may cause trouble can occur with epinephrine, MAO inhibitors, thyroid hormone, cimetidine, and centrally acting antihypertensives. Dosage should start low, increasing usually by 25 mg every 4 to 5 days until a therapeutic level is reached. Failure of a noradrenergic antidepressant after 4 to 5 weeks can be followed by a trial of a serotonergic drug. Drug serum level monitoring is useful for imipramine, desipramine, and nortriptyline. Monoamine oxidase inhibitors are effective in many elderly patients who are resistant to TCAs. Sympathomimetic drugs must be avoided with MAOIs. Elderly patients are at high risk of toxicity and drug interactions with lithium. Electroconvulsive therapy is useful for patients who do not respond to drug treatment, but medical complications, particularly cardiovascular, often occur in patients 75 or older. Many patients relapse after ECT. Psychotherapy together with pharmacotherapy may be the optimal treatment for elderly depressives. Older patients are more likely to become chronically depressed than younger patients. The risk of suicide in depressed elderly males is high, particularly in those with psychosocial problems, and depression rises with age.
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PMID:Management of depression in the elderly. 266 41


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