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Stroke medicine for the geriatrician 2010

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  29 April 2010

SL Keir  and
K Strachan
SL Keir*
Affiliation:
Department of Medicine for the Elderly, Western General Hospital, Edinburgh, UK
K Strachan
Affiliation:
Department of Medicine for the Elderly, Western General Hospital, Edinburgh, UK
*
Address for correspondence: Dr Sarah Keir, Department of Medicine for the Elderly, Western General Hospital, Crewe Road, Edinburgh EH4 2XU. Email: [email protected]
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Summary

This review explores the recent advances in investigation and treatment of acute stroke, as well as its secondary prevention, with emphasis on the relevance of the evidence for the older population. Hyperacute reperfusion treatment is becoming increasingly embedded into the day-to-day management of stroke and trials are ongoing that will help determine its safety in the older patient. Managing all stroke patients in a stroke unit is known to improve outcome and recent work has helped to inform care decisions. Application of the robust data available on secondary prevention treatments may have to be weighed alongside the degree of frailty of the patient for whom treatment is being considered.

Keywords

strokethrombolysisstroke unitstreatmentelderly
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 2 , May 2010 , pp. 92 - 104
Copyright
Copyright © Cambridge University Press 2010

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References

1General Registrar Office for Scotland. Scotland's population 2007 – The Registrar General's Annual Review of Demographic Trends. Available at: http://www.gro-scotland.gov.uk/statistics/publications-and-data/annual-report-publications/rgs-annual-review-2007.Google Scholar
2Rothwell, PM, Coull, AJ, Giles, MF et al. Change in stroke incidence, mortality, case fatality, severity and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004; 363: 1925–33.CrossRefGoogle ScholarPubMed
3Libman, RB, Wirkowski, E, Alvir, J, Rao, H. Conditions that mimic stroke in the Emergency Department. Implications for acute stroke trials. Arch Neurol 1995; 52: 1119–22.CrossRefGoogle ScholarPubMed
4Koudstaal, PJ, van Gijn, J, Frenken, CWGM, Hijdra, A, Lodder, J, Vermeulen, M et al. TIA, RIND, minor stroke: a continuum, or different subgroups? J Neurol Neurosurg Psychiatry 1992; 55: 95–97.CrossRefGoogle ScholarPubMed
5Kothari, RU, Pancioli, A, Liu, T, Brott, T, Broderick, J. Cinncinati Pre-hospital Stroke Scale: reproducibility and validity. Ann Emerg Med 1999; 33: 373–78.CrossRefGoogle Scholar
6Harbison, J, Hossain, O, Jenkinson, D et al. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke 2003; 34: 71–76.CrossRefGoogle ScholarPubMed
7Wardlaw, JM, Seymour, J, Cairns, J et al. Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life. Stroke 2004; 35: 2477–83.CrossRefGoogle ScholarPubMed
8Wardlaw, JM, Keir, SL, Dennis, MS. The impact of delays in computed tomography of the brain on the accuracy of diagnosis and subsequent management in patients with minor stroke. J Neurol Neurosurg Psychiatry 2003; 74: 77–81.CrossRefGoogle ScholarPubMed
9Dimigen, M, Keir, S, Dennis, M, Wardlaw, J. Long-term visibility of primary intracerebral haemorrhage on magnetic resonance imaging. J Stroke Cerebrovasc Dis 2004; 3: 104–8.CrossRefGoogle Scholar
10Keir, SL, Wardlaw, JM, Bastin, ME, Dennis, MS. In which patients is diffusion-weighted MR imaging most useful in routine stroke care? J Neuroimaging 2004; 14: 118–22.Google ScholarPubMed
11Hacke, W, Albers, G, Al-Rawi, et al. The Desmotoplase in Acute Ischaemic Stroke Trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmotoplase. Stroke 2005; 36: 66–73.CrossRefGoogle Scholar
12Albers, GW, Thijs, VN, Wechsler, L et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 2006; 60: 508–17.CrossRefGoogle ScholarPubMed
13Davis, S, Donnan, GA, Parsons, MW et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo controlled randomised trial. Lancet Neurology 2008; 7: 299–309.CrossRefGoogle ScholarPubMed
14Rivers, CS, Wardlaw, JM, Armitage, PA et al. Do acute diffusion- and perfusion-weighted MRI lesions identify final infarct volume in ischaemic stroke? Stroke 2006; 37: 98–104.CrossRefGoogle Scholar
15National Collaborating Centre for Chronic Conditions. Stroke: national clinical guidelines for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians.Google Scholar
16Wardlaw, JM, Murray, V, Berge, E, del Zoppo, GJ, Yamaguchi, T, Berge, E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2009, issue 1. Art. no. CD0002213. doi:10.1002/14651858.CD000213.pub2.CrossRefGoogle Scholar
17Wahlgren, N, Ahmed, N, Davolos, A et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369: 275–82.CrossRefGoogle ScholarPubMed
18Hacke, W, Kaste, M, Bluhmki, E et al. Thrombolysis with Alteplase 3 to 4.5 hours after Acute Ischaemic Stroke (ECASS-III). N Eng J Med 2008; 359: 1317–29.CrossRefGoogle Scholar
19Sandercock, P, Lindley, R, Wardlaw, JM et al. The third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Trials 2008; 9: 37. doi:10.1186/1745-6215-9-37.CrossRefGoogle ScholarPubMed
20Tatlisumak, T, Soinila, S, Kaste, M. Telestroke networking offers multiple benefits beyond thrombolysis. Cerebrovasc Dis 2009; 27 suppl 4: 21–27.CrossRefGoogle ScholarPubMed
21Sandercock PAG, Counsell, C, Kamal, AK. Anticoagulants for acute ischaemic stroke. Cochrane Database Syst Rev 2008, issue 4. Art. no. CD000024. doi:10.1002/14651858.CD000024.pub3.CrossRefGoogle Scholar
22Lindley, RI, Wardlaw, JM, Sandercock, PAG, Rimdusid, P, Lewis, SC, Signorini, DF. Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction. J Stroke Cerebrovasc Dis 2004; 13: 235–46.CrossRefGoogle ScholarPubMed
23Chen, ZM, Sandercock, P, Pan, HC, Counsell, C, Collins, R, Liu, LS et al. Indications for early aspirin use in acute ischaemic stroke: A combined analysis of 40,000 randomised patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke 2000; 31: 1240–49.CrossRefGoogle Scholar
24Mendelow, AD, Gregsonow, BA, Fernandes, HM et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005; 365: 387–97.CrossRefGoogle Scholar
25STICH II Trial home page. Available at: http://www.ncl.ac.uk/stich/Google Scholar
26Vahedi, K, Vicaut, E, Mateo, J et al. Sequential-Design, Multicenter, Randomized, Controlled Trial of Early Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction (DECIMAL Trial). Stroke 2007; 38: 2506–17.CrossRefGoogle ScholarPubMed
27Juttler, E, Schwab, S, Schmiedek, P et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY). A randomized control trial. Stroke 2007; 38: 2518–25.CrossRefGoogle Scholar
28Hofmeijer, J, Kappelle, L, Algra, A. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 2009; 8: 326–33.CrossRefGoogle Scholar
29Vahedi, K, Hofmeijer, E, Vicaut, E et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6: 215–22.CrossRefGoogle ScholarPubMed
30Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2007, issue 4. Art. no. CD000197. doi:10.1002/14651858.CD000197.pub2.CrossRefGoogle Scholar
31Greer, DM, Funk, SE, Reaven, NL, Ouzounelli, M, Uman, GC. Impact of fever on outcome in patients with stroke and neurologic injury. A comprehensive meta-analysis. Stroke 2008; 39: 3029–35.CrossRefGoogle ScholarPubMed
32Kammersgaard, LP, Jorgensen, HS, Rungby, JA, Reith, J, Nakayama, H, Weber, UJ et al. Admission body temperature predicts long-term mortality after acute stroke: the Copenhagen Stroke Study. Stroke 2002; 33: 1759–62.CrossRefGoogle ScholarPubMed
33Den Hertog, HM, van der Worp, HB, Tseng, MC, Dippel, DWJ. Cooling therapy for acute stroke. Cochrane Database Syst Rev 2009, issue 1. Art no. CD001247. doi:10.1002/14651858.CD001247.pub2.CrossRefGoogle Scholar
34Williams, LS, Rotich, J, Qi, R, Fineberg, N, Espay, A, Bruno, A et al. Effects of admission hyperglycaemia on mortality and costs in acute ischaemic stroke. Neurology 2002; 59: 67–71.CrossRefGoogle Scholar
35Gray, CS, Hildreth, AJ, Sandercock, PA et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 2007; 6: 397–406.CrossRefGoogle ScholarPubMed
36Roffe, C, Sills, S, Wilde, K, Crome, P. Effect of hemiparetic stroke on pulse oximetry readings on the affected side. Stroke 2001; 32: 1808–10.CrossRefGoogle ScholarPubMed
37Ronning, OM, Guldvog, B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomised controlled trial. Stroke 1999; 30: 2033–37.CrossRefGoogle Scholar
38Bennett, MH, Wasiak, J, Schnabel, A, Kranke, P, French, C. Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database Syst Rev 2005, issue 3. Art. no. CD004954. doi:10.1002/14651858.CD004954.pub2.CrossRefGoogle Scholar
39Bhalla, A, Sankaralingam, S, Dundas, R, Swaminathan, R, Wolfe, CDA, Rudd, A. Influence of raised plasma osmolality on clinical outcome after stroke. Stroke 2000; 31: 2043–48.CrossRefGoogle Scholar
40Asplund, K. Haemodilution for acute ischaemic stroke. Cochrane Database Syst Rev 2002, issue 4. Art. no. CD000103. doi:10.1002/14651858.CD000103.CrossRefGoogle Scholar
41Robinson, TG, Potter, JF. Blood pressure in acute stroke. Age Ageing 2004; 33: 6–12.CrossRefGoogle ScholarPubMed
42Leonardi-Bee, J, Bath, PM, Phillips, SJ, Sandercock, PA, IST Collaborative Group. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 2002; 33: 1315–20.CrossRefGoogle Scholar
43Castillo, J, Leira, R, Garcia, MM, Serena, J, Blanco, M, Davalos, A. Blood pressure decrease during the acute phase of ischaemic stroke is associated with brain injury and poor stroke outcome. Stroke 2004; 35: 520–26.CrossRefGoogle ScholarPubMed
44Potter, JF, Robinson, TG, Ford, GA et al. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol 2009; 8: 48–56.CrossRefGoogle ScholarPubMed
45ENOS home page. Available at: http://www.enos.ac.uk/Google Scholar
46COSSACS Trial Group. COSSACS (Continue or Stop Post-Stroke Antihypertensives Collaborative Study): rationale and design. J Hypertens 2005; 23: 455–58.CrossRefGoogle Scholar
47Kelly, J, Rudd, A, Lewis, RR, Coshall, C, Moody, A, Hunt, BJ. Venous thromboembolism after acute stroke: a prospective study using magnetic resonance direct thrombus imaging. Stroke 2004; 35: 2320–55.CrossRefGoogle ScholarPubMed
48Sherman, DG, Albers, GW, Bladin, C et al. The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomised comparison. Lancet 2007; 369: 1347–55.CrossRefGoogle ScholarPubMed
49International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet 1997; 349: 1569–81.CrossRefGoogle Scholar
50Wells, PS, Lensing, AWA, Hirsh, J.Graduated compression stockings in the prevention of postoperative venous thromboembolism: a meta-analysis. Arch Intern Med 1994; 154: 67–72.CrossRefGoogle ScholarPubMed
51The CLOTS Trials Collaboration. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 2009; 373: 1958–65.CrossRefGoogle Scholar
52CLOTS Collaboration homepage. Available at: http://www.clotstrial.comGoogle Scholar
53Dennis, MS, Lewis, S, Warlow, C; FOOD trial Collaboration. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365: 755–63.Google ScholarPubMed
54Dennis, MS, Lewis, S, Warlow, C; FOOD trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365: 764–72.Google ScholarPubMed
55Coull, AJ, Lovett, JK, Rothwell, PM. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 2004; 328: 326–28.CrossRefGoogle ScholarPubMed
56Rothwell, PM, Giles, MF, Chandratheva, A et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007; 370: 1432–42.CrossRefGoogle ScholarPubMed
57Peto, R, Lopez, AD, Boreham, J, Thun, M, Heath, C. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992; 339: 1268–78.CrossRefGoogle ScholarPubMed
58MacMahon, S, Peto, R, Cutler, JA et al. Blood pressure, stroke and coronary heart disease, part I: Effects of prolonged differences in blood pressure – evidence from nine prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–74.CrossRefGoogle ScholarPubMed
59Rodgers, A, MacMahon, S, Gamble, G et al. Blood pressure and risk of stroke in patients with cerebrovascular disease. BMJ 1996; 313: 147.CrossRefGoogle ScholarPubMed
60PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033–41.CrossRefGoogle Scholar
61The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–53.CrossRefGoogle Scholar
62Manktelow, BN, Potter, JF. Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database Syst Rev 2009, issue 3. Art. no. CD002091. doi:10.1002/14651858.CD002091.pub2.CrossRefGoogle Scholar
63Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20,536 people with cerebrovascular disease or other high-risk conditions. Lancet 2004; 363: 757–67.CrossRefGoogle Scholar
64Shepherd, J, Blauw, GJ, Murphy, MB et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623–30.CrossRefGoogle Scholar
65Anonymous. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351: 1379–87.CrossRefGoogle Scholar
66North American Symptomatic Carotid Endarterectomy Trial, Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445–53.CrossRefGoogle Scholar
67Rothwell, PM, Eliasziw, M, Gutnikov, SA, Warlow, CP, Barnett, HJM, for the Carotid Endarterectomy Trialists’ Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915–24.CrossRefGoogle ScholarPubMed
68Collaboration, AT. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ 2002; 324: 71–86.CrossRefGoogle Scholar
69The Esprit Study Group. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 2006; 367: 1665–73.CrossRefGoogle Scholar
70CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348: 1329–39.CrossRefGoogle Scholar
71Diener, HC, Sacco, R, Yusuf, S et al. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol 2008; 7: 875–84.CrossRefGoogle Scholar
72Diener, HC, Bogousslavsky, J, Brass, LM. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364: 331–37.CrossRefGoogle ScholarPubMed
73Bhatt, DL, Fox, K, Hacke, W et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354: 1706–17.CrossRefGoogle ScholarPubMed
74Wolf, PA, Abbott, RD, Kannel, WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983–88.CrossRefGoogle ScholarPubMed
75Aguilar, MI, Hart, R. Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev 2005, issue 3. Art. no. CD001927. doi:10.1002/14651858.CD001927.pub2.CrossRefGoogle Scholar
76Van Walraven, C, Hart, RG, Singer, DE et al. Oral anticoagulants versus aspirin in non-valvular atrial fibrillation: an individual meta-analysis. JAMA 2002; 288: 2441–48.CrossRefGoogle Scholar
77Hylek, E, Evans-Molina, C, Shea, C, Henault, L, Regan, S. Major haemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 2007; 115: 2689–96.CrossRefGoogle ScholarPubMed
78Mant, J, Hobbs, FDR, Fletcher, K et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007; 370: 493–503.CrossRefGoogle Scholar
79Rash, A, Downes, T, Portner, R, Yeo, WW, Morgan, N, Channer, KS. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO). Age Ageing 2007; 36: 151–56.CrossRefGoogle ScholarPubMed
80Healey, JS, Hart, RG, Pogue, J et al. Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation. According to Stroke Risk: The Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE-W). Stroke 2008; 39: 1482–86.CrossRefGoogle ScholarPubMed
81The ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360: 2066–78.CrossRefGoogle Scholar
82Connolly, SJ, Ezekowitz, MD, Yusuf, S. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139–51.CrossRefGoogle ScholarPubMed
83A randomised trial of anticoagulants versus aspirin after cerebral ischaemia of presumed arterial origin. The Stroke Prevention in Reversible Ischaemia Trial (SPIRIT) Study Group. Annals Neurol 1997; 42: 857–65.Google Scholar
84Medium intensity oral anticoagulants versus aspirin after cerebral ischaemia of arterial origin (ESPRIT): a randomised controlled trial. Lancet Neurology 2007; 6: 115–24.CrossRefGoogle Scholar