Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Ischemic Stroke in Elderly - Introduction to Geriatrics - Lecture Slides, Slides of Geriatrics

Ischemic Stroke in Elderly, Thrombolysis, Sources of Ischemic Stroke, Systemic Hypoperfusion, Cardioembolic Stroke, Aging Brain, Atrial Fibrillation, Carotid Stenosis are some points from Introduction to Geriatrics lecture.

Typology: Slides

2011/2012

Uploaded on 12/13/2012

sethuraman_h34rt
sethuraman_h34rt 🇮🇳

4.3

(8)

159 documents

1 / 14

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Docsity.com
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe

Partial preview of the text

Download Ischemic Stroke in Elderly - Introduction to Geriatrics - Lecture Slides and more Slides Geriatrics in PDF only on Docsity!

Outline:

 Etiology  Age related changes to the brain and stroke risk factors  Epidemiology  Outcome  Thrombolysis  Conclusion

The Aging brain:

 Decreased brain weight (0.3-0.5% per year in people > 70)  Enlarged ventricles and thickened choroid plexus  Disruption of local perfusion due to microvasculature changes  Increase in BBB permeability  ?neuronal loss vs neuronal atrophy  ?changes in ion transporters and neurotransmitter production The question remains….how do these changes affect the vulnerability of the brain?

Age related risk factors for

ischemic stroke:

 Female  Atrial fibrillation  Cardiovascular diseases (ischemic heart disease and heart failure)  Carotid stenosis  Hypertension (more important <80 yo)  High blood cholesterol

Stroke outcomes:

 Feb 2010, Circulation published a retrospective study to compare age related differences in patients with ischemic stroke  April 2003 to March 2009 included 502 036 ischemic stroke patients from 1256 hospitals around the United States  33.5% of patients were >80yrs old  Pts >90yo vs pts <50 yo: ○ Incase hospital fatality: 10.3% vs 3% (p <0.001) ○ Discharged to LTC: 42.1% vs 5.3% (p <0.001) ○ Unable to ambulate: 40.1% vs 9.6% (p<0.001)

Criteria for rtPA in acute stroke:

 Onset of symptoms within 3 hours  “Large” neurologic deficit that isn’t improving  No contraindications including:  CT evidence of cerebral hemorrhage or mass effect  Blood pressure >185/  Use of anticoagulants within past 48hrs (increased INR, PTT or low platelets)  Recent stroke, head injury, major bleeding or major surgery  Seizures at onset of stroke  Glucose <3 or >  MI within 3 weeks

However….

 The European Journal of Neurology compared the outcome of the use of rtPA in pts >80yo with those <80yo  July 2001 to May 2007 prospectively assessed 157 pts treated with IV rtPA within 3hrs of stroke  Pts were followed with CT or MRI and NIHSS  Baseline NIHSS score and neuro changes after IV rtPA were not different between elderly and non-elderly at 1 hour, 1 day, 7 days and finally at 90 days

Cont’d….

 Mortality in elderly was 6% vs 10% in non- elderly (not significant)  Severe intracranial hemorrhage was 6% in elderly vs 5.5% in non-elderly (not significant)  The ONLY independent risk factor for worse outcome was the severity NIHSS score prior to rtPA administration  Conclusion: elderly should not be denied rtPA if they fit the criteria for administration and RCT’s are needed for proper evaluation.

Age and Aging cont’d….

 Rate of “poor outcome” (modified Rankin score 4-5 or death) was higher in the elderly (p<0.0001)  Rate of “favourable outcome” (modified Rankin score 0-1) was not significantly different between groups (p=0.37)  Conclusion: Patients >80yo received rtPA benefit from the therapy though they are more likely to have a clinically poor outcome relative to younger patients

Nature reviews neurology Sept

 Data indicates that elderly patients with stroke show marked improvement following rtPA  Studies suggest that the risk of ICH and mortality are not increased when using rtPA in the elderly vs younger pts.  In Conclusion: for more objective conclusions relating to the use of rtPA in elderly patients RCTs including this population are required