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

Improvement in end-of-life-care is required for patients dying with chronic kidney disease (CKD). The UK government now recommends that tools such as the Liverpool Care Pathway for the Dying Patient (LCP) be used to enhance the care of those patients dying with CKD. The LCP was originally developed for patients dying with terminal cancer, however has been shown to be transferable to patients dying with heart failure or stroke. On this background, in 2005 a UK National Renal LCP Steering Group was formed. The aim was to determine whether or not the generic LCP was transferable to patients dying with CKD. An Expert Consensus sub-group was established to produce evidence-based prescribing guidelines to allow safe and effective symptom control for patients dying with renal failure. These guidelines were finalised by the Expert Consensus group in August 2007 and endorsed by the Department of Health in March 2008. A literature search on symptom control and end-of-life care in renal failure was performed. A summary of the evidence was presented at a National Steering Group meeting. Opinions were given and provisional guidelines discussed. A first draft was produced and individually reviewed by all members of the Expert Group. Following review, amendments were made and a second draft written. This was presented to the entire National Steering Group and again individual comments were taken into consideration. A third and fourth draft were written and individually reviewed, before the guidelines were finalised by the Expert Consensus group. Patients dying with advanced CKD suffer symptoms similar to patients dying of cancer. The Renal LCP prescribing guidelines aim to control the same symptoms as the generic LCP: pain, dyspnoea, terminal restlessness and agitation, nausea and respiratory tract secretions. The evidence for the production of the guidelines is discussed and how a consensus was reached. A summary of the guidelines is given and the complete guidelines document is available via the Marie Curie Palliative Care Institute, Liverpool website.
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PMID:Symptom management for the adult patient dying with advanced chronic kidney disease: a review of the literature and development of evidence-based guidelines by a United Kingdom Expert Consensus Group. 1927 66

Agitation and aggression are frequently occurring and distressing behavioral and psychological symptoms of dementia (BPSD). These symptoms are disturbing for individuals with Alzheimer disease, commonly confer risk to the patient and others, and present a major management challenge for clinicians. The most widely prescribed pharmacological treatments for these symptoms-atypical antipsychotics-have a modest but significant beneficial effect in the short-term treatment (over 6-12 weeks) of aggression but limited benefits in longer term therapy. Benefits are less well established for other symptoms of agitation. In addition, concerns are growing over the potential for serious adverse outcomes with these treatments, including stroke and death. A detailed consideration of other pharmacological and nonpharmacological approaches to agitation and aggression in patients with Alzheimer disease is, therefore, imperative. This article reviews the increasing evidence in support of psychological interventions or alternative therapies (such as aromatherapy) as a first-line management strategy for agitation, as well as the potential pharmacological alternatives to atypical antipsychotics-preliminary evidence for memantine, carbamazepine, and citalopram is encouraging.
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PMID:Management of agitation and aggression associated with Alzheimer disease. 1948 82

The authors report a rare case of slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after radial artery/external carotid artery-middle cerebral artery bypass graft surgery for an intracavernous carotid artery aneurysm. Under barbiturate protection, a 69-year-old man underwent high-flow bypass surgery combined with carotid artery sacrifice for a symptomatic intracavernous aneurysm. The patient became restless postoperatively, and this restlessness peaked on postoperative Day (POD) 7. Diffusion-weighted and FLAIR MR images obtained on PODs 1 and 7 revealed subtle cortical hyperintensity in the temporal cortex subjected to temporary occlusion. On POD 13, (123)I-iomazenil ((123)I-IMZ) SPECT clearly showed increased distribution on the early image and mildly decreased binding on the delayed image with count ratios of the affected-unaffected corresponding regions of interest of 1.23 and 0.84, respectively, suggesting postischemic hyperperfusion. This was consistent with the finding on (123)I-iodoamphetamine SPECT. Of note, neuronal density in the affected cortex on the delayed (123)I-IMZ image further decreased to the affected/unaffected ratio of 0.44 on POD 55 during the subacute stage when characteristic cortical hyperintensity on T1-weighted MR imaging, typical of cortical laminar necrosis, was emerging. The affected cortex showed marked atrophy 8 months after the operation despite complete neurological recovery. This report illustrates, for the first time, dynamic neuroradiological correlations between slowly progressive neuronal death shown by (123)I-IMZ SPECT and cortical laminar necrosis on MR imaging in human stroke.
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PMID:Slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after high-flow bypass for a carotid intracavernous aneurysm. 1987 3

Atrial fibrillation is the most common arrhythmia encountered in clinical practice. It can cause severe complications such as congestive heart failure and stroke. However, identification of prime targets for efficient therapeutic intervention remains a challenge. In vitro rabbit heart models of ischemia-, stretch-, and cholinergic agitation-induced atrial fibrillation were developed, and pharmacological interventions of mitochondrial translocator protein (TSPO) were adopted to explore the role of the mitochondrial protein in the aforementioned atrial fibrillations. Fura-2 AM and Mg(2+)-Fura-2 AM were used to monitor the alterations of intracellular Ca(2+) and ATP respectively under chemical ischemia or cholinergic agitation. The results showed that inhibition of TSPO significantly reduced the incidence of all three types of atrial fibrillation. In addition, TSPO inhibition ameliorated the cytoplasmic Ca(2+) overload and energy compromise facing to chemical ischemia or cholinergic agitation in HL-1 cells, an atrial muscle cell line. Thus, TSPO may be an important molecule in the context of different kinds of atrial fibrillation, and a novel and common target for atrial fibrillation treatment.
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PMID:Inhibition of mitochondrial translocator protein prevents atrial fibrillation. 2012 99

Falls of patients represent the most frequent reported incidents in our 541-bed urban public hospital, reaching more than 200 occurrences per year.This prompted a fall-prevention program consisting of several steps: i) descriptive analysis of 295 consecutive falls in order to look at the factors commonly supposed to be associated with falls, among physical, psychic and pathological characteristics of patients, medication, circumstances or environmental hazards, ii) case-control study on 10 medicine and surgery wards of high risk (178 patients), designed to identify which factors are discriminant to predict the falls, iii) proposal of a fall-risk assessment score to be calculated at the admission of the patient, iv) if the risk is confirmed, implementation of general and specific actions identified by the components of the score. The score is based on a 15-point scale including age older than 65 years, history of previous falls, weakness or insufficient weight, impaired mobility or altered feet state, psychic disorders (depression-agitation-risky behavior), neuro-psychiatric diseases (CVA-confusion-dementia), fever or infection, polypharmacy. The mean scores of fallers and of control patients were 7.53 +/- 3.02 and 4.81 +/- 2.93 respectively (p < 0.000001). A score range between 5 and 11 was chosen to start the fall prevention program, which may predict a large proportion (about 80%) of valid patients prone to falls in the assessed medical and surgical wards (scores higher than 11 correspond to severely diseased, often bedridden invalid patients, not suspected to fall). However, these criteria are not suitable for nursing homes and for long-staying patients.
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PMID:[Putting into place devices for prevention of falls at the hospital center at Haguenau]. 2018 Mar 37

Neuropsychiatric symptoms are frequent and troublesome in people with dementia and present a major treatment challenge for clinicians. Most good practice guidelines suggest non-pharmacological treatments as the first-line therapy and there is emerging evidence, including randomized controlled trials, that a variety of psychological and training interventions, including social interaction and person-centred care training, are effective. There is evidence from meta-analyses that some atypical antipsychotic drugs, specifically risperidone and aripiprazole, confer benefit in the treatment of aggression in people with Alzheimer's disease over a period of up to 12 weeks. However, these benefits have to be considered in the context of significant adverse events, including extrapyramidal symptoms, accelerated cognitive decline, stroke and death. In addition, the limited evidence available does not indicate ongoing treatment benefits over longer periods of therapy. The evidence is limited for other pharmacological treatment approaches, but the best evidence is probably for carbamazepine, memantine and citalopram. There is very limited evidence for any therapies in non-Alzheimer dementias. In conclusion, it is important in most situations to limit the use of antipsychotic medication to short-term treatment (up to 12 weeks) of severe neuropsychiatric symptoms to limit harm. Non-pharmacological therapies offer a viable and effective alternative in many situations. Adequately powered randomized controlled trials for the treatment of clinically significant agitation are urgently needed to explore alternative pharmacological therapies.
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PMID:Management of neuropsychiatric symptoms in people with dementia. 2080 86

Disulfiram (tetraethylthiuram disulfide) has been used for almost 60 years in the treatment of alcohol addiction. It causes aversive behavior due to disulfiram-ethanol reaction (DER). The classical DER includes flush, sweating, tremor, nausea, vomiting, tachycardia, moderate decrease in blood pressure and restlessness. Complete recovery is the usual outcome in clinical settings. Life-threatening reactions are rare but sometimes occur. We present a case of a 53-year-old man developing severe hypotension and ischemic stroke as a result of disulfiram treatment and ethanol intake. Use of adrenalin as a drug of choice in this critical condition, together with other therapeutic approaches led to stabilization of hemodynamics and reversal of neurological symptoms. Our case had a favorable outcome, but it should be remembered that patients unable to comply to the strong restrictions in treatment for alcohol rejection are not eligible for this therapeutic modality used in the management of alcohol dependency.
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PMID:Severe hypotension and ischemic stroke after disulfiram-ethanol reaction. 2105 76

Delirium is a term used variously to characterize a change in behavior. Neurologists most often use the term to describe a patient who has acutely developed a hyperactive agitated state. In many patients, agitation and overactivity are explained by toxic and metabolic factors and infections. Lesions, especially strokes, in some brain regions have been reported to cause sudden agitation and a hyperactive state, often with an increased amount of speech output, the topics of which flit from one subject to another. Strokes and other lesions that involve the temporal lobes, fusiform and lingual gyri, caudate nucleus, and anterior cingulum have been reported to cause an acute hyperactive state similar to that found in patients with delirium tremens related to alcohol withdrawal.
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PMID:Delirium: a neurologist's view--the neurology of agitation and overactivity. 2120 26

Few studies have reported neuropsychiatric symptoms (NPS) in primary progressive aphasia (PPA), a neurodegenerative disorder that primarily affects the left hemisphere. Depression is associated with left-sided stroke, but it remains unclear whether depression and other NPS are also associated with PPA. The authors compared the frequency of neuropsychiatric symptoms in 55 cases of PPA with 110 cognitively normal persons matched for age, sex, and education. Depression, apathy, agitation, anxiety, appetite change, and irritability are associated with PPA. Hallucinations, delusions, and night-time behavior were not associated with PPA.
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PMID:Neuropsychiatric aspects of primary progressive aphasia. 2167 45

Abuse of the psychoactive "designer drug" methylenedioxypyrovalerone (MDPV) has become a serious international public health concern because of the severity of its physical and behavioral toxicities. MDPV is the primary ingredient in so-called "bath salts," labeled as such to avoid criminal prosecution and has only been classified recently as a controlled substance in the United States and some other countries. However, it remains a danger because of illegal sources, including the Internet. MDPV is a synthetic, cathinone-derivative, central nervous system stimulant and is taken to produce a cocaine- or methamphetamine-like high. Administered via oral ingestion, nasal insufflation, smoking, intravenous or intramuscular methods, or the rectum, the intoxication lasts 6 to 8 hours and has high addictive potential. Overdoses are characterized by profound toxicities, causing increased attention by emergency department and law enforcement personnel. Physical manifestations range from tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, and seizures to those as severe as stroke, cerebral edema, cardiorespiratory collapse, myocardial infarction, and death. Behavioral effects include panic attacks, anxiety, agitation, severe paranoia, hallucinations, psychosis, suicidal ideation, self-mutilation, and behavior that is aggressive, violent, and self-destructive. Treatment is principally supportive and focuses on counteracting the sympathetic overstimulation, including sedation with intravenous benzodiazepines, seizure-prevention measures, intravenous fluids, close (eg, intensive care unit) monitoring, and restraints to prevent harm to self or others. Clinical presentation is often complicated by coingestion of other psychoactive substances that may alter the treatment approach. Clinicians need to be especially vigilant in that MDPV is not detected by routine drug screens and overdoses can be life-threatening.
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PMID:Psychoactive "bath salts" intoxication with methylenedioxypyrovalerone. 2268 91


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