BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. Many physicians remain reluctant to provide stroke prevention by anticoagulant therapy especially for elderly individuals with AF. Using multivariate regression analyses, we studied the characteristics and the prognosis of stroke in patients with AF. METHODS: The study is part of the Copenhagen Stroke Study, a prospective, community-based study of 1197 patients with acute stroke treated on a stroke unit from the time of acute admission to the end of rehabilitation. Initial stroke severity was measured by the Scandinavian Neurological Stroke Scale (SSS). Neurological and functional outcomes were evaluated by the SSS and the Barthel Index. RESULTS: AF was diagnosed in 18% of the patients. AF increased steeply with age in the stroke population, from 2% in patients or = 90 years of age. In a multivariate analysis AF was associated with age (odds ratio [OR], 2.0 per 10-year increase; 95% confidence ratio [CI], 1.6 to 2.6), ischemic heart disease (OR, 3.4; 95% CI, 2.4 to 4.8), previous stroke (OR, 1.8; 95% CI, 1.2 to 2.6), and systolic blood pressure (OR, 0.93 per 10-mm Hg increases; 95% CI, 0.88 to 0.99), but not with sex, diabetes, hypertension, previous transient ischemic attack, or silent infarction on computed tomography. Patients with AF had a higher mortality rate (OR, 1.7; 95% CI, 1.2 to 2.5), longer hospital stays (50 days versus 40 days, P
Orientation is an indicator of general intellectual function and is defined as the ability to report time, place, and personal data. Our knowledge of orientation in acute stroke is sparse. We examined the frequency of impaired orientation in acute stroke, its determinants, and recovery in 653 consecutive patients with acute stroke who were not unconscious and who were without severe aphasia. Prospective assessments of orientation and stroke severity were done by the Scandinavian Neurologic Stroke Scale at the time of acute admission and hereafter weekly until the end of rehabilitation. Impaired orientation was found in 23% of the patients on acute admission and in 12% of the survivors after completed rehabilitation. A stationary level of orientation was achieved by 80% of the patients within 2 weeks and by 95% within 6 weeks. A multiple linear regression analysis found neurological score (B = 0.027, SE(B) = 0.003), age (B = -0.013, SE(B) = 0.003), and comorbidity (B = -0.023, SE(B) = 0.078), but not sex, prior stroke, handedness, or side of stroke lesion to be significant independent determinants of orientation score on acute admission. Lesions involving the anterior and medial thalamus and/or any of the cerebral lobes were associated with impaired orientation. In conclusion, impaired orientation is frequent in acute stroke and the time-course of recovery is similar to what has been found in other neuropsychological impairments with the major part of recovery early after stroke onset.
BACKGROUND AND PURPOSE: This study was undertaken to determine factors of importance for the development of leukoaraiosis and to evaluate whether leukoaraiosis influences stroke outcome. METHODS: The study was prospective and consecutive and included 1084 unselected patients with acute stroke and transient ischemic attack admitted from the community of Bispebjerg (Copenhagen, Denmark) during a 25-month period from September 1, 1991, to September 30, 1993. All patients were treated in a stroke unit from the time of acute admission to completion of rehabilitation. Daily alcohol consumption and other putative risk factors were registered on admission, and patients were evaluated weekly to death or time of completed rehabilitation by means of neurological (Scandinavian Stroke Scale) and functional (Barthel Index) scores. Leukoaraiosis was diagnosed on computed tomographic scan. Multivariate analyses were applied to test relations independent of other influencing factors. RESULTS: Leukoaraiosis was present in 15% of the patients. Age was the only factor that significantly increased the risk of leukoaraiosis (odds ratio [OR] per 10-year increase, 2.4; 95% confidence interval [CI], 1.8 to 3.1), whereas the presence of atrial fibrillation was adversely related to leukoaraiosis (OR, 0.26; 95% CI, 0.13 to 0.52). Moderate daily alcohol consumption (1 to 5 drinks) reduced the risk of leukoaraiosis (OR, 0.50; 95% CI, 0.28 to 0.87), whereas heavy daily alcohol consumption (> 5 drinks) tended to increase the risk (OR, 1.3; 95% CI, 0.5 to 3.3). Leukoaraiosis was not related to the presence of hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent claudication, smoking, or sex. The presence of leukoaraiosis had no influence on neurological outcome (P = .20), functional outcome (P = .47), length of hospital stay (P = .75), or mortality (P = .31). CONCLUSIONS: Moderate daily alcohol intake seems associated with a decreased risk of leukoaraiosis in stroke patients. The relation between alcohol intake and leukoaraiosis may even be U-shaped, like the relation between alcohol intake and coronary heart disease, alcohol intake and mortality, and alcohol intake and stroke. The presence of leukoaraiosis does not seem to influence the rehabilitation process or outcome of stroke.
OBJECTIVES: The majority of stroke patients with initial leg paralysis do not regain independent walking. We characterize the minority who, despite initial leg paralysis, regained independent walking. DESIGN: Consecutive and community based. SETTING: A stroke unit receiving all stroke patients from a well-defined community. PATIENTS: A total of 859 acute stroke patients; 157 (15%) initially had leg paralysis. MAIN OUTCOME MEASURES: Scandinavian Stroke Scale (SSS) and Barthel index (BI) on admission and weekly during rehabilitation. Univariate and multivariate statistics were considered. RESULTS: Of the 157 patients with initial leg paralysis, 84 (60%) died; 73 (40%) survived. Fifteen (21%) survivors regained walking function (the walking group), and 58 (79%) did not (the nonwalking group). The BI on admission was the only factor of significant predictive value (p
Our objective was to study age-specific prevalence, computed tomographic (CT) characteristics, risk factors, and the prognostic influence on stroke outcome of silent infarction in acute stroke patients.
The study was prospective and community-based and included 801 acute stroke patients, of whom 587 had first-ever stroke. A CT scan was performed in 500 (85%) of the 587 patients with first-ever stroke. CT was reviewed blindly, and infarcts were classified according to patient history as silent or symptomatic. Patients were evaluated initially with the Mini-Mental State Examination (MMSE) and weekly with both the Scandinavian Stroke Scale (SSS) and the Barthel Index (BI) from the onset of stroke to completion of rehabilitation. CT characteristics, risk factors, and stroke outcome were compared in stroke patients with and without silent infarction.
The prevalence of silent infarction in patients with first-ever stroke and recurrent strokes was similar, at 29% (group aged 0 to 54 years, 16%; 55 to 64 years, 22%; 65 to 74 years, 30%; 75 years or older, 33%). Silent infarcts were small and subcortical. Independent risk factors were increasing age (odds ratio [OR], 1.95 per 25 years; confidence interval [CI], 1.19 to 3.15), hypertension (OR, 1.75; CI, 1.13 to 2.70), claudication (OR, 1.74; CI, 1.01 to 3.00), and male sex (OR, 1.72; CI, 1.12 to 2.64); other stroke risk factors such as atrial fibrillation and former transient ischemic attack were not independent risk factors. Patients with and without silent infarction did not differ in frequency of prestroke home care (P = .2). MMSE (P = .56), initial BI (P = .62) and SSS score (P = .08), BI (P = .85) and SSS score (P = .75) after completion of rehabilitation, or in the speed of recovery (P = .85). Length of hospital stay, mortality rate, and discharge rate to nursing home also did not differ between the two groups.
This community-based study shows that silent infarction in stroke patients is more related to certain stroke risk factors than others and that silent infarction does not seem to influence the prognosis of stroke.