Stroke in elderly

Major adverse effects include weight gain and bloating. It may increase the risk of stroke in elderly women. 

Kidwell CS, Alger JR, Di Salle F, Starkman S, Villablanca P, Bentson J, Saver JL (1999) Diffusion MRI in patients with transient ischemic attacks. Stroke 30 1174-1180 KimuraM,Sejima H.Ozasa H,YamaguchiS(1998)Technetium-99m-HMPAO SPECT in patients with hemiconvulsions followed by Todd s paralysis. Pediatr Radiol 28 92-94 Kleiner-Fisman G, Kott HS (1998) Myasthenia gravis mimicking stroke in elderly patients. Mayo Clin Proc 73 1077-1078... 

Kleiner-Fisman G, Kott HS (1998). Myasthenia gravis mimicking stroke in elderly patients. Mayo Clinic Proceedings. 73 1077-1078... 

As discussed in Chapters 7 and 9, one size does not fit all. The risk of stroke in elderly patients given fibrinoljdic drugs must be addressed with respect to utilizing a pharmacoinvasive approach. Prompt, complete, and sustained recanaUzation and restoration of myocardial perfusion are imperative objectives in all patients with STEMI. Thus, the risk of stroke in the elderly must be addressed by refinement of treatment modalities in this particularly high-risk group. Such an approach is suggested in Chapter 7, in which Drs. Antman and Braunwald... 

In temperature extremes, patients taking antipsychotics may experience their body temperature adjusting to ambient temperature (poikilother-mia). Hyperpyrexia can lead to heat stroke. Hypothermia is also a risk, particularly in elderly patients. These problems are more common with the use of low-potency FGAs. 

Sunderland T, Tariot PN, Newhouse PA. (1988). Differential responsivity of mood, behavior, and cognition to cholinergic agents in elderly neuropsychiatric populations. Brain Res. 472 4y. 371-89. Tachikawa E, Kudo K, Flarada K, Kashimoto T, Miyate Y, Kakizaki A, Takahashi E. (1999). Effects of ginseng saponins on responses induced by various receptor stimuli. EurJ Pharmacol 369(1) 23-32. Tagami M, Ikeda K, Yamagata K, Nara Y, Fujino FI, Kubota A, Numano F, Yamori Y. (1999). Vitamin E prevents apoptosis in hippocampal neurons caused by cerebral ischemia and reperfusion in stroke-prone spontaneously hypertensive rats. Lab Invest. 79(5) 609-15. 

Cerebrovascuiar effects Gerebrovascular adverse reactions (eg, stroke, transient ischemic attack), including fatalities, were reported in patients (mean, 85 years of age range, 73 to 97 years of age) in trials of risperidone in elderly patients with dementia-related psychosis. 

Ritalin and related generic methylphenidate drugs are available by prescription for individuals six years and older. Ritalin is distributed in 5, 10, and 20 mg tablets. In addition to ADHD, methylphenidate is used for several other medical conditions. It continues to be used for narcolepsy. It has also been used in treating depression, especially in elderly populations. Methylphenidate has been suggested for use in the treatment of brain injury from stroke or brain trauma it has also been suggested to improve appetite and the mood of cancer and HIV patients. Another use is for pain control and/or sedation for patients using opiates. 

Teramoto S., Matsuse T., and Ouchi T. (1999). Amantadine and pneumonia in elderly stroke patients. Lancet 353 2156-2157. 

I. The clinical recognition of subcortical arteriosclerotic encephalopathy in elderly neuropsychiatric patients. J Geriatr Psychiatry Neurol 2 123-133 Szabo K, Bazner H, Kern R, Blahak C, Hennerici MG, Gass A (2004) Lack of incidental DWI hyperintensity in healthy elderly individuals. Cerebrovasc Dis [Suppl] 5 75 Tanaka Y, Tanaka O, Mizuno Y, Yoshida M (1989) A radiologic study of dynamic processes in lacunar dementia. Stroke 20 1488-1493... 

In addition, numerous life-threatening adverse reactions have come to the forefront with the newer atypicals, such as hypertension cardiovascular disease, including stroke in the elderly obesity elevated serum cholesterol elevated blood sugar diabetes and pancreatitis. Finally, there is compelling new evidence linking neuroleptic use to premature death. 

Q1 A stroke involves significant reduction in blood flow to a part of the brain. It can be caused either (i) by an embolus or by intravascular clotting, which blocks blood flow to an area (approximately 85% of strokes), or (ii) by haemorrhage from a ruptured blood vessel, which compresses the brain tissue (approximately 15% of strokes). Patients with extensive atherosclerosis are at risk of intravascular coagulation and blockage of cerebral blood flow, but a vessel can be blocked by a thrombus originating in another part of the circulation. This cause of stroke is common in elderly patients >60 years of age. Aneurysms which rupture suddenly are a more common cause of stroke in younger patients. 

Special care should be taken when using amphetamines in elderly patients, in view of the likelihood of stimulation of adrenoceptors and in particular of cardiovascular and respiratory function. Periodic users especially need to be wary of acute use under circumstances of exercise and environmental heat, owing to the risk of heat stroke. 

The strength of the association between blood pressure and stroke is attenuated with increasing age, although the absolute risk of stroke in the elderly is far higher than in the young (Lewington et al. 2002). Nevertheless, hypertension is still a risk factor in the very... 

Nattel S, Opie L (2006). Controversies in atrial fibrillation. Lancet 367 262-272 Ngeh J, Gupta S, Goodbourn C et al. (2003). Chlamydia pneumoniae in elderly patients with stroke (C-PEPS) a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease. Cerebrovascular Diseases 15 11-16... 

Atheromatous medium-sized arteries at the base of the brain, particularly the vertebral and basilar arteries, may become affected by dolichoectasia. The arteries are widened, tortuous and elongated and may be visualized on MRI or, if the walls are calcified, on CT. Dolichoectasia is usually found in elderly patients with hypertension and diabetes and it may cause stroke through embolization of thrombus or by occlusion of small branch arteries. In younger patients, it should raise the possibility of Fabry s disease. 

Gradual onset of stroke over hours or days, rather than seconds or minutes, is unusual and is much more likely to occur in ischemic than in hemorrhagic stroke. If the onset is gradual, and not Ukely to be caused by low flow or migraine (Ch. 8), then a structural intracranial lesion must be excluded. In younger patients, multiple sclerosis should also be considered. However, focal neurological deficits that develop over hours, or up to two days, in elderly patients are still most likely to have a vascular cause since vascular disease is so common in older patients. 

Pneumonia is a common complication in elderly patients confined to bed. Chest infection is particularly common after stroke because of impairment in swallow and cough reflex, poor respiratory movement and pulmonary embolism. The risks can be reduced by good nursing and chest physiotherapy. A pharyngeal airway may be required, particularly in drowsy patients or after a brainstem stroke, and ventilation may be considered in certain patients. 

Patients in atrial fibrillation who have a TIA or stroke without other clear etiology should be given anticoagulation therapy if there are no contraindications (European Atrial Fibrillation Trial Study Group 1993, 1995). Recent studies have shown that warfarin is as safe as aspirin in elderly patients with atrial fibrillation (Rash et al. 2007 Mant et al. 2007). Patients with presumed cardioembolic TIA or stroke secondary to other causes should certainly receive antithrombotic therapy. Also they may benefit from anticoagulation in certain circumstances, such as intracardiac mural thrombosis after myocardial infarction, although there have been no randomized trials in situations other than non-valvular atrial fibrillation. 

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