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

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

The clinical manifestations and computed tomographic (CT) findings of small intracerebral haematomas (ICHs) were studied in 31 consecutive cases which comprised 6% of 520 cases of non-traumatic, non-neoplastic ICH confirmed by CT in a 3-year period. A small ICH was defined by CT as a sharply demarcated high density area with the maximum dimension not exceeding 20 mm and on no more than two contiguous 10-mm scan sections. The ages ranged from 50 to 85 years, being between 50 and 69 in about two thirds. Twenty-nine patients (93%) were hypertensive. The haematoma was in the capsulothalamus (9 cases), thalamus (6 cases), capsuloputamen (6 cases), subthalmus (2 cases), internal capsule (2 cases) pons (4 cases), midbrain (1 case), and cerebellum (1 case). Headache (4 cases) and vomiting (3 cases) were rare, whereas dizziness was rather frequent (16 cases). None had loss of consciousness. The essential clinical manifestations were sensorimotor deficits in 13 cases, pure motor hemiparesis in 6, pure sensory disturbance in 4, and involuntary movements in 2. Five patients with haemorrhage in the brain stem presented with various syndromes. None of the 31 cases had a fatal outcome directly due to the small haemorrhagic stroke. Two patients had recurrent stroke; a small, deep infarct in 1 and a large haemorrhage in the other. Full neurological and functional recovery was made in 17 cases (56.7%), recovery with mild sequelae in 7 (23.3%) and little recovery in 6. Poor recovery was related to the location (pons), the age (above 75 years), and the presence of involuntary movements. Some clinical features common to lacunar infarcts and small ICHs were discussed, and the possibility of a combination of these two conditions in a same hypertensive patient was raised. Small ICH as a type of benign, non-fatal stroke is not infrequent in communities where the incidence of hypertensive ICH is relatively high. CT scanning in the early stage of stroke even for patients with mild neurological symptoms may enhance the detection rate of such small ICHs.
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PMID:Small intracerebral haemorrhage: a study of clinical manifestations and CT findings on 31 cases. 400 23

With the purpose of identifying specific features in aged hemiplegic patients, 818 cases referred to a geriatric-rehabilitation hospital after hip fracture were studied. In 66 cases a cerebro-vascular accident had preceded the fracture, which was ipsilateral in 52 cases. No differences were found in incidence of concurrent disease, hospitalization time, mortality and functional recovery between hip fracture patients with and without a history of stroke, except that an interval of less than a week between stroke and fracture was associated with poor functional recovery. We conclude that rehabilitation of the stroke patient with hip fracture is worthwhile.
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PMID:Hip fracture in stroke patients. Epidemiology and rehabilitation. 403 71

The increasingly accurate prediction of survival and functional recovery in patients with stroke will be of value in planning both their individual management and the health and social services needed. To establish the independent predictive effects of a range of personal and clinical characteristics, data on 900 patients admitted to Northwick Park Hospital with stroke were analysed by stepwise multiple regression. Older patients who lose consciousness at the outset and show signs of multiple neurological deficits, abnormal pupils, and conjugate deviation of the eyes are more likely to die within a year than those without these characteristics. Those who survive the acute episode and are discharged alive are more likely to die within a year if they are old and have sensory loss with severe physical disability. Older female patients who are incontinent, lose consciousness at the onset of stroke, sustain extensive motor deficits in combination with other neurological deficits, and have residual disabilities from previous strokes are particularly likely to be severely disabled on discharge from hospital. Routinely collected clinical data enable useful forecasts about mortality and disability after stroke. The accuracy of these forecasts can probably be improved further.
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PMID:Predictors of mortality and disability in stroke. 622 68

Although experimental studies suggest that blood cardioplegia provides better protection than crystalloid cardioplegia, clinical studies have been inconclusive. Ninety patients undergoing coronary bypass grafting were randomized to receive either blood (n = 43) or crystalloid cardioplegia (n = 47). The incidence of perioperative myocardial infarction was lower with blood cardioplegia (blood, n = 0; crystalloid, n = 5; p = 0.06), and the maximum MB isoenzyme of creatine kinase was significantly less with blood cardioplegia (blood, 26.3 +/- 12.6 U/L; crystalloid, 35.6 +/- 17.0 U/L, mean +/- standard deviation; p less than 0.02.) Sixty patients (blood cardioplegia, n = 28; crystalloid cardioplegia, n = 32) had more sensitive measurements to assess the metabolic response to aortic occlusion and to compare the metabolic and functional recovery from the operation. Coronary sinus blood flow (by the continuous thermodilution technique) was significantly lower after cross-clamp removal with blood cardioplegia (blood, 160 +/- 100 ml/min; crystalloid, 220 +/- 120 ml/min; p less than 0.05), indicating less reactive hyperemia. The cardiac production of lactate was significantly less with blood cardioplegia during aortic occlusion (blood, -0.5 +/- 0.9 mmol/L; crystalloid, -0.9 +/- 0.9 mmol/L; p less than 0.05) and immediately after aortic declamping (blood, -0.2 +/- 0.4 mmol/L; crystalloid, -0.7 +/- 0.7 mmol/L; p less than 0.01). Thermodilution cardiac output measurements permitted calculation of the left ventricular stroke work index, and nuclear ventriculograms permitted calculation of the left ventricular end-diastolic volume index and end-systolic volume index. Myocardial performance, systolic elastance, and diastolic compliance were determined from volume loading studies (250 to 500 ml colloid) performed 2 to 4 hours postoperatively. Myocardial performance (the left ventricular stroke work index-left ventricular end-diastolic volume index relation) and systolic elastance (the systolic blood pressure-left ventricular end-systolic volume index relation) were significantly better with blood cardioplegia (p less than 0.01 by multivariate analysis); diastolic compliance (the left atrial pressure-left ventricular end-diastolic volume index relation) was similar. Blood cardioplegia reduced ischemic injury, decreased anaerobic metabolism during arrest, and permitted better functional recovery. Blood cardioplegia provides superior protection for elective coronary bypass grafting and may improve the clinical results in patients with unstable angina and in other high-risk patients.
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PMID:A clinical trial of blood and crystalloid cardioplegia. 638 86

This study assesses whether an appropriately designed asanguineous initial reperfusate effectively reduces the reperfusion injury following prolonged global ischemia and improves the recovery of cardiac performance after cardioplegic arrest. Forty-eight isolated perfused working rat hearts underwent two hours of hypothermic (15 degrees to 18 degrees C) ischemic arrest followed by 30 minutes of normothermic reperfusion. During ischemic injury, multidose cardioplegia was delivered at 30-minute intervals. The reperfusion solution under study was infused during the last 3 minutes of ischemia, just prior to release of the aortic clamp. The usual hemodynamic variables of this preparation (heart rate, aortic pressure, aortic flow, coronary flow, and stroke volume) were serially recorded and expressed as percent of recovery of control values. The influence of the concentration of Ca2+, pH, and buffer was more specifically investigated. A reperfusate containing 1 mM of Ca2+ was found to result in higher postischemic hemodynamic values than a Ca2+-poor (0.25 mM) reperfusate. The best functional recovery was provided by an alkalotic (pH 7.70 at 28 degrees C), glutamate-enriched initial reperfusate, which, by 30 minutes of reperfusion, yielded a 93.5 +/- 2.3% recovery of aortic flow versus 83.6 +/- 1.8% in the control group receiving unmodified reperfusion (p less than 0.01). We conclude that an appropriate composition of the initial reperfusate can improve the recovery of cardiac function significantly following two hours of cardioplegic arrest and that such an improvement can be achieved by an asanguineous reperfusate provided its composition is properly designed with respect to electrolytes, pH, and substrates.
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PMID:Protective effect of an asanguineous reperfusion solution on myocardial performance following cardioplegic arrest. 642 70

This study investigated the importance of the side of weakness and sex of the patient in patient outcome after stroke. It was based upon 162 consecutive acute stroke patients attending a rehabilitation unit. Results suggest that functional recovery was not influenced by the factors investigated, provided that measurements were made at set times poststroke. However, patients with right hemiplegia attended rehabilitation longer so they appeared to have made a better functional recovery when activity of daily living (ADL) ability was measured at discharge. Although right hemiplegia was associated with aphasia and left hemiplegia with spatial disorder and loss of sitting balance, these associations were not strong enough to affect functional recovery. Sex of the patient had no significant effect upon either the frequency of initial deficits or upon outcome, and there was no obvious interaction between the two variables (side and sex) and outcome.
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PMID:Stroke: influence of patient's sex and side of weakness on outcome. 647 82

Temporary aortic occlusion produces a consistent degree of spinal cord injury in the unanesthetized rabbit. This 'spinal stroke' model was utilized to examine the potential therapeutic effects of the opiate antagonist naloxone in central nervous system ischemia. Naloxone treatment resulted in dose-related enhancement of motor recovery; greatest functional recovery was observed in rabbits treated with a dose of 2 mg/kg per h. This dose compares well with the high doses of naloxone shown to have a beneficial effect in other experimental models of stroke and spinal injury. In contrast, clinical stroke studies, which have been largely unsuccessful, have utilized naloxone doses which are several orders of magnitude lower than those successfully employed in experimental models.
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PMID:Naloxone in experimental spinal cord ischemia: dose-response studies. 647 24

This study establishes intratester reliability for all components of physical performance and intertester reliability for the total scores of upper and lower extremity motor performance in a cumulative numerical scoring system devised by Fugl-Meyer et al. Intertester reliability was found to be high for the total scores of upper and lower extremity motor performance. All intratester and intertester reliability coefficients were high and statistically significant. Establishing the reliability of the Fugl-Meyer method of assessing recovery of function following cerebrovascular accident has increased the usefulness of this method for clinical assessment and as a tool for the comparative analysis of the effectiveness of various therapeutic interventions.
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PMID:Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. 662 35

We studied recovery of function in 41 patients with right hemisphere stroke. Recovery was rapid for left neglect, prosopagnosia, anosognosia, and unilateral spatial neglect on drawing (USN). Recovery was slower for h mianopia, hemiparesis, motor impersistence, and extinction. Rates of recovery were intermediate for constructional apraxia and dressing apraxia. Sex had no influence on the rate of recovery. Younger patients recovered from prosopagnosia more rapidly than older patients. Patients with smaller lesions recovered more quickly from anosognosia, USN, and hemiparesis than patients with larger lesions. Patients with hemorrhages recovered more rapidly from constructional apraxia, neglect, and motor impersistence than patients with infarcts. Recovery of function and the factors influencing recovery can by studied systematically by life table methods.
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PMID:Recovery of behavioral abnormalities after right hemisphere stroke. 668 80


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