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

Of 1721 consecutive autopsies performed on patients over 60 years of age in Tokyo Metropolitan Geriatric Hospital, 550 (32% of all autopsied cases) revealed symptomatic cerebrovascular lesions. Among the 550 patients, intracranial hemorrhage was found in 19%, cerebral infarction in 75%, and coexisting cerebral hemorrhage and cerebral infarction in 6%. Twenty-eight percent of the cerebral infarctions were embolic infarctions of cardiac origin, half of which were caused by nonvalvular atrial fibrillation, and 69% were non-embolic infarctions of cardiac origin. Progressive subcortical vascular encephalopathy accounted for 15% of the cerebral infarctions. Two-thirds of all lobar cerebral hemorrhages were amyloid angiopathy-related. Nonvalvular atrial fibrillation is the most important cardiac source of embolic stroke. Progressive subcortical vascular encephalopathy is one of the characteristic features of ischemic lesions, and cerebral amyloid angiopathy is an important cause of lobar cerebral hemorrhage in the aged.
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PMID:Subtypes and proportions of cerebrovascular disease in an autopsy series in a Japanese geriatric hospital. 228 May 80

The medical records and autopsy data of patients over the age of 70 years at death with a diagnosis of intracerebral hemorrhage (ICH) in the Yokufukai Geriatric Hospital were reviewed. All cases with ICH caused by head injury, rupture aneurysms or arteriovenous malformations were excluded from this study. There were 73 autopsied cases with spontaneous ICH from January 1978 to September 1988. There were 33 men and 40 women. Fourteen percent of the patients had a stroke while hospitalized for another disorder. Their ages at death ranged from 70 to 99 years with a mean of 81.8 years. Of these, 48 cases (66%) were 70 years or older at the time of ICH. In the senile ICH (over 70 years), the following characteristics were observed; (1) the most common location was the thalamus, which accounted for 33.3% of the hemorrhage. (2) subcortical and cerebellar hemorrhage accounted for 16.6% and 14.6% of the total, respectively. (3) there was no pontine hemorrhage. Fifty-seven percent had anamnestic hypertension before the stroke. The ages at which they became bedridden state ranged from 62 to 92 years with a mean of 79.5 years. This study revealed that the non-organic factors such as insidious generalized muscular weakness or decreased spontaneity were important as causes of the deterioration of ADL in the chronic stage of the senile ICH. Within one year after becoming bedridden state, 76.1% of all patients died. The bedridden state in the elderly with the residuals of ICH indicated a poor prognosis. As causes of death, pneumonia occurred in 28.8% of all patients, brain death in 19.2%, and sudden death in 12.3%.
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PMID:[Cerebrovascular disease in the elderly--a clinicopathological study of 73 autopsied cases with intracerebral hemorrhage]. 236 29

Geriatric day hospitals are commonly used in the rehabilitation of stroke. However, there is little objective evidence about its effect for this condition. The potential advantages and disadvantages are finely balanced and further research, including cost-effectiveness analysis, is needed to define more clearly the role of this expensive facility.
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PMID:Day hospital and stroke patients. 251 66

We compared three self-rating scales (the Geriatric Depression Scale, the Zung Scale, and the Center for Epidemiologic Studies Depression Scale) with three examiner-rating scales (the Hamilton Rating Scale, the Comprehensive Psychopathological Rating Scale-Depression, and the Cornell Scale), to see which was best for 40 elderly (mean age 80 years) stroke patients, 17 of whom were depressed according to clinical examination. External validity and concurrent validity were good for all except the Cornell Scale. Reliability (internal consistency) showed that some items were not significantly correlated, which might be explained by our selection of the patients. The Geriatric Depression Scale, the Zung Scale, and the Comprehensive Psychopathological Rating Scale-Depression had the highest sensitivity, and the Zung Scale had the highest positive predictive value (93%). With regard to internal consistency, sensitivity, and predictive value, the best self-rating scales were the Geriatric Depression and the Zung scales and the best examiner-rating scale was the Comprehensive Psychopathological Rating Scale-Depression.
Stroke 1989 Sep
PMID:Comparison of six depression rating scales in geriatric stroke patients. 277 80

An elderly female who had suffered a stroke was admitted to the Jewish Institute for Geriatric Care (JIGC) for rehabilitation. Three years previously she was found to have a pituitary macroadenoma (prolactinoma) that was treated with radiation therapy. She had been on thyroid replacement for secondary hypothyroidism. Upon admission she was found to have severe cognitive impairment in association with a low plasma cortisol level. After treatment with prednisone there was a dramatic improvement in cognitive function and the patient was able to participate in a rehabilitation program.
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PMID:Cortisol deficient state. A cause of reversible cognitive impairment and delirium in the elderly. 290 4

There is some evidence that the rehabilitation of patients who have suffered a stroke may be more successful if conducted in a specialist unit, especially if started soon after the stroke. Departments of Geriatric Medicine are often unable to accept all invitations to take over the rehabilitation of elderly patients who have suffered a stroke. As specialist rehabilitation resources are scarce, it is necessary to be able to distinguish the patients whose outcome will be improved by specialist rehabilitation from those whose recovery (whether good or bad) will not be significantly influenced. Patients with an Edinburgh prognostic score of 5.6 four weeks after the stroke are very likely always to require total nursing care even after specialist rehabilitation. A Guy's Hospital prognostic score of 10 or more seems to indicate that functional independence will be recovered even without specialist rehabilitation. Patients with an Edinburgh prognostic score of 3-4 within the first 4 weeks after the stroke should not be denied specialist rehabilitation; there is evidence, admittedly weak, that it is for them that the benefits may be greatest. A major study is now required to validate the Edinburgh and Guy's prognostic scores prospectively and to test whether it is valid to use them for the triage of elderly patients for specialist rehabilitation. In addition, it is possible that a specialist unit would be better able to help patients with specific 'barriers' to rehabilitation. Adequate tools for the identification and objective assessment of these barriers are essential if this possibility is to be tested.
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PMID:Assessment for rehabilitation after stroke. 304 66

Carotid arterial disease was investigated with a Duplex Scanner using Power Frequency Spectrum Analysis. Sixty-one carotid systems were evaluated noninvasively and angiographically, while 20 controls were examined and assumed to be normal. Peak frequency and 50% frequency bandwidth, a quantitative index of spectral broadening, were correlated with the percentage of stenosis. Peak frequency predicted the presence or absence of hemodynamically significant stenoses (greater than or equal to 50% diameter reduction) with 90.8% accuracy, while 50% frequency bandwidth correctly identified similar lesions with 93.2% accuracy (p = NS). Also, with the latter results, carotid systems were grouped into less than 25%, 25% to 49%, and greater than or equal to 50% stenosis categories with an 86.4% accuracy. Similar statistical evaluation was attempted for peak frequency results. It was not possible to separate hemodynamically insignificant lesions (less than 50% diameter reduction) into distinct groups because of the overlap of results among those arteries with less than 50% stenosis. Finally, all eight occluded internal carotid arteries were identified with combined Doppler/imaging analysis. However, with imaging alone, only 5 of 8 (63%) occluded arteries were correctly identified.
Stroke
PMID:Range-gated pulsed Doppler power frequency spectrum analysis for the diagnosis of carotid arterial occlusive disease. 353 38

Contralateral obstructions have been suggested to be responsible for inaccuracy in Doppler sonographic diagnosis and estimation of severity of internal carotid artery stenoses. Therefore correlations of the systolic peak frequency of the internal carotid artery (Doppler-Frequency-Spectrum-Analysis) and severity of stenoses found by angiography have been compared in subgroups with (n = 36) and without (n = 48) additional contralateral obstructions. The linear regressions in both subgroups were found to be very similar (Y = 0.0098X - 12.4 and Y = 0.0099X - 14.0), the coefficients of correlation identical (r = 0.83). In 26 patients, the systolic peak frequency of the internal carotid artery did not demonstrate a significant change due to operation of the contralateral vascular lesion; thus indicating that contralateral obstructions do not influence CW-Doppler sonographic findings of an ipsilateral vessel wall lesion concerning diagnostic accuracy and non-invasive estimation of the severity of stenoses.
Stroke
PMID:Influence of contralateral obstructions on Doppler-frequency spectral analysis of ipsilateral stenoses of the carotid arteries. 390 23

One-hundred-ninety elderly (mean age 75.8 years), disabled patients at risk of being institutionalized due to stroke, acute medical problems, dementia, and other illnesses completed a rehabilitation program at the Geriatric Rehabilitation Unit (GRU). A retrospective study to measure possible impacts of rehabilitation on functional status and placement at discharge from the GRU and on living situation 1 year postdischarge showed an improvement of functional status after rehabilitation in nearly all patients. By discharge, the number of patients with partial or total activities of daily living (ADL) independence increased from 87 to 173, ambulatory patients increased from 42 to 127, continent patients from 89 to 141 and mentally clear patients from 40 to 91. Higher ratings in these parameters at discharge were associated with better placement and significantly lower mortality 1 year postdischarge. Patients placed in noninstitutional settings had a lower (21%) mortality rate when compared with patients placed in nursing homes (mortality 45%). The GRU program is clearly associated with improved outcome of care.
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PMID:Geriatric Rehabilitation Unit: a 3-year outcome evaluation. 394 Dec 55

Of 4100 consecutive admissions to the Department of Geriatric Medicine, 414 patients (10.1%) were identified as having atrial fibrillation (AF); 138 (33%) had transient AF and 276 (67%) had constant AF. In the constant group, 41.7% of patients had had a stroke compared with 26.8% in the transient group (P less than 0.01). A random sample of 200 patients in sinus rhythm from the 4100 admissions had a stroke prevalence of 19%. This study suggests that constant AF has a greater association with stroke than transient AF.
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PMID:Atrial fibrillation and stroke in elderly hospitalized patients. 396 63


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