ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Survivors of stroke are often left with severe mental and physical disabilities, which create a major social and economic burden. Many investigators have attempted to assess the role of rehabilitation in reducing such disability. Few controlled studies provide accurate assessment and documentation of benefit. Because of the presence of multiple variables and inadequate measures of outcome, it is difficult to design studies evaluating the effectiveness of rehabilitation for stroke. It is unclear bow early rehabilitation should begin and what aspects of rehabilitation are important. Intensive rehabilitation is an expensive and limited resource; thus, the ability to identify the subgroup of patients with stroke who are likely to benefit is a critical issue. Although preliminary guidelines for the selection of patients who are appropriate for rehabilitation are given, no uniform criteria reliably differentiate patients who need rehabilitation from those who will recover spontaneously or do poorly. Controlled studies in the practice of rehabilitation for stroke will provide much useful information for patient management.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A multicenter retrospective audit of carotid endarterectomies performed during 1981 was completed with 46 institutions contributing 3,328 cases. Overall, there was a 2.5% risk of transient neurological dysfunction following surgery and a 6% risk of stroke or death. The intra‐institutional combined major morbidity and mortality varied from 21% to 0. Those institutions with greater than 700 beds had a statistically lower incidence of stroke or death than did other institutions. The incidence of stroke or death postoperatively was significantly lower for patients who were operated on for amaurosis fugax or for unspecified reasons. Those patients who were operated on for a progressing stroke had a higher incidence of stroke but this group was at greatest risk for stroke without surgery. The incidence of postoperative stroke or death was related to the type of arterial repair; vein patch grafting was statistically better than both fabric patch grafting and primary closure. When all patients who were not monitored during surgery were compared to all patients who had electroencephalographic (EEC) monitoring, there was found to be a significant statistical difference in favor of the EEG group. Endarterectomy combined with coronary artery bypass or simultaneous bilateral endarterectomies had a statistically significant higher incidence of stroke or death than did unilateral carotid endarterectomy.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The clinical outcome in 110 patients admitted to a non‐intensive stroke unit was compared to that in 183 patients treated for acute stroke in general medical wards. At entry, the two groups of patients were closely similar in all prognostic indicators. Subsets of patients were analyzed in an attempt to identify groups that benefit more than others from stroke unit care.The stroke unit regime had little effect on short‐term and long‐term mortality rates in the entire stroke population as well as in subgroups. But after the care in the stroke unit, the need for long‐term hospitalizatlon hi survivors was reduced (p = 0.0001). This difference hi favour of the stroke unit was independent of the patients' age, the extent of neurological deficit on admission and previous history. In subgroups where the general prognosis is fair or good (minor neurological deficits and < 75 yrs), SU care accelerated the process of rehabilitation, but the need for institutional care very late after the stroke was influenced only little. In groups with a poor general prognosis (major deficits and> 75 yrs), the ultimate proportion of patients able to return home was enhanced by SU care. It is concluded that care in a stroke unit benefits the great majority of stroke patients and that such a unit should be designed to admit all acute stroke patients without selection.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A study of 774 patients in eastern North Carolina was undertaken to determine the effects of a coordinated program of care and follow‐up on recovery from stroke. The program was designed to coordinate and improve in‐hospital stroke care and rehabilitation, to provide for education and training of the family for post‐hospital care, and to coordinate and facilitate continued access to services after discharge.As measured by the Barthel Index at discharge, three, six and 12 months, the impact of the program was found to be minimal. Patients' scores throughout follow‐up were influenced by age, whether the stroke event was new or recurrent, and the state of consciousness at admission. Follow‐up Barthel scores were also related to scores obtained at discharge.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Focal cerebral ischemia hi humans increases the Incidence of cardiac arrhythmias, and serum cardiac enzyme and plasma norepinephrine levels. In addition, systemic administration of catecholamines causes myocardial damage. This suggests that cerebral ischemia may cause myocardial damage as a consequence of elevated plasma norepinephrine levels. Therefore, experiments were done hi 23 chloralosed, paralyzed and artificially ventilated cats to investigate the effects of occluding (n = 17) or sham‐occluding (n = 6) the left middle cerebral artery on the myocardium and on circulating levels of plasma catecholamines. After occlusion of the middle cerebral artery for 12–22 hr, 41% (7/17) of the hearts had either acute myocardial necrosis (3/7), focal hemorrhage (3/7), or both (177). In anlmah with acute myocardial damage the levels of plasma norepinephrine and epinephrine were significantly increased compared to pre–middle cerebral artery occlusion values (+ 46 ± 18% and +142 ± 45%, respectively). As well, meats with acute myocardial damage, changes from initial levels of plasma norepinephrine and epinephrine were significantly Increased over those of experimental cats without acute myocardial damage. In animals which did not have acute myocardial damage (10/17) the circulating plasma levels of catecholamines were not significantly different from pre‐occlusion values. Similarly, sham occlusion did not alter plasma catecholamine levels. These data demonstrate that a percentage of animals subjected to middle cerebral artery occlusion have myocardial damage and an increase hi plasma concentration of norepinephrine and epinephrine. This suggests that a rise hi plasma catecholamine levels, due to Increased sympathetic activity after middle cerebral artery occlusion, may cause myocardial damage.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A retrospective case note survey of 139 cases of carotid territory TIAs was carried out. Angiographlc evidence of carotid stenosis was more frequently encountered when the patient's attacks consisted of symptoms suggestive of ischemia of small cortical territories with involvement restricted to the arm or leg or to dysphasia. Attacks of hemiparesis affecting face, arm and leg, or arm and leg were less often associated with carotid stenosis. If patients described any attacks of a restricted nature the chance of finding carotid stenosis was 47%, if not 16%. It is argued that these findings are a reflection of the varied pathogenesis of TIAs, and the relevance of this heterogeneity to the interpretation of clinical trials is briefly mentioned.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Non‐invasive carotid artery testing was performed on 500 consecutive patients with visual disturbances not related to local ophthalmic pathology to determine the extent of carotid artery disease, particularly in patients with symptoms not typical of amaurosis fugax. Three hundred eighty six patients (77.2%) had an abnormal study. However, the incidence of hemodynamkaHy significant lesions was only 16%. The patients could be divided into three groups: 1) Patients with symptoms that could be explained on an ocular basis, including amaurosis fugax, had a 79% Incidence of ipsilateral carotid plaques. 2) Patients with symptoms which could not be easily explained on an ocular basis, such as bilateral blurred vision, bilateral visual loss (both transient and permanent), and homonymous hemianopsia had an incidence of carotid artery plaques similar to patients with amaurosis fugax. 3) Patients with unilateral blurred vision and bilateral scintillations had a lower Incidence (57%) of carotid plaques than the other groups. Younger symptomatic patients had less carotid plaques than the overall series. Twenty‐one percent of patients under age 50 had the Doppler finding of early systolic flutter turbulence, which is usually of mitral valve origin. Women predominated In the under 50 age group by about 2:1. In view of the prevalence of carotid plaques In the population of patients with visual symptoms other than amaurosis fugax, evaluation of these patients with non‐invasive testing is indicated to determine which of these patients has hemodynamicaily significant obstruction to flow at the carotid artery bifurcation.

ISSN:0039-2499    

出版商:OVID    

年代:1986

数据来源: OVID