Stroke in geriatric patients admitted to the intermediate care of internal medicine
Keywords:
stroke, cerebral infarction, cerebral hemorrhage, cerebrovascular disorders, olderAbstract
Introduction: The knowledge and control of the stroke patient can contribute to improve the prognosis.
Objective: To characterize geriatric patients with stroke, who enter the intermediate care unit of medicine.
Methods: an observational and cross-sectional study was carried out, in geriatric patients admitted with stroke, in the medicine intermediate care room of the Hospital Militar Central Dr. Luis Díaz Soto. The universe was 680 patients with the clinical and imaging diagnosis of stroke. Variables studied were: age, sex, clinical forms, NIHSS indexes, personal pathological history, morbidity, lethality, and dependency status.
Results: The ischemic form predominated (94%), the age from 65 to 74 years (40%), the male sex (61.5%) and the NIHSS index less than 20 points (82.7%). High blood pressure, previous cerebrovascular disease and diabetes mellitus were the most frequent antecedents. The lethality was 10.0% and the most frequent complication was bronchopneumonia (16.9%). 40% presented a state of total dependency.
Conclusions: Patients were characterized by the predominance of the ischemic form, of the male sex, age between 70 and 79 years, and bronchopneumonia as a complication. The high NIHSS index was associated with an unsatisfactory evolution and although the overall case fatality was not high, the presence of the state of total dependence was important. This requires significant rehabilitation work to achieve an acceptable quality of life.
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References
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19. Escobar Alfonso V, Zaldívar Garit M, Rodríguez de la Rosa G, Cabrera Cordobés JC. Factores de riesgos prevalentes en pacientes ingresados por enfermedad cerebrovascular. Rev. Cub Med Mil. 2014 [acceso: 23/10/2015];43(4):[aprox. 9 pant.]. Disponible en: https://scielo.sld.cu/scielo.php? script=sci_arttext&pid=S0138-65572014000400003
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22. Strachinariu RT. The role of endothelial dysfunction in the pathogenesis of vascular complications of diabetes mellitus - a high priority area of investigation. Rom J Diabetes Nutr Metab Dis. 2015[acceso: 06/02/2016].22(1):61-6. Disponible en: https://www.degruyter.com/downloadpdf/j/rjdnmd.2015.22.issue-1/rjdnmd-2015-0008/rjdnmd-2015-0008.xml
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25. Iglesias Mohedano AM, García Pastor A, Villanueva Osorio JA, Gil Núñez AC. Protocolos de práctica asistencial: Protocolo de atención del ictus en Urgencias. Medicine-Programa de Formación Médica Continuada Acreditado. 2015[acceso: 07/03/2016];11(89):5337-42. Disponible en: https://www.sciencedirect.com/science/article/pii/S0304541215002875
26. Vila García LO, Hernández Pedroso W, Castillo López B, Ramos Ravelo D, Lemer Rodríguez A, Santana Sánchez R. Caracterización de los factores modificables asociados a la letalidad hospitalaria del ictus. Rev. Cub Med Mil. 2017 [acceso: 03/06/2018];46(2):160-73. Disponible en: https://www.revmedmilitar.sld.cu/index.php/mil/article/view/37/52
27. Pérez García AR, García Montero A, Sosa Acosta EF, Padrón Valdés F. Factores pronósticos de mortalidad por hemorragia intracerebral en el periodo agudo. Rev. Cub Med Mil. 2015[acceso: 03/03/2016];44(3):[aprox. 11 p.]. Disponible en:https://scielo.sld.cu/scielo.php?pid=S0138-65572015000300002&script=sci_arttext&tlng=pt
28. Heldner MR, Zubler C, Mattle HP , Schroth G , Weck A , Mono ML, et al. Utility of National Institutes of Health Stroke Scale. Stroke. 2013[acceso: 20/11/2014]; 44(4):1153-7. Disponible en: https://www.ahajournals.org/doi/full/10.1161/strokeaha.111.000604
29. Heiss WD, Kidwell CS. Imaging for Prediction of Functional Outcome and Assessment of Recovery in Ischemic Stroke. Stroke. 2014[acceso: 30/10/2015];45(4):1195-201. Disponible en: https://www.ahajournals.org/doi/full/10.1161/strokeaha.113.003611
30. Pozo Rivero A, Fernández Lora F, Fernández Lora L. Repercusión de factores clínico epidemiológicos sobre el pronóstico de las hemorragias intraparenquimatosas. Medisan. 2010[acceso: 11/07/2011];14(6):747-53. Disponible en: https://www.bvs.sld.cu/revistas/san/vol_14_6_10/san02610.pdf
31. Heitsch L, Panagos P, Morkos El Hayek S. Urgencias neurológicas. Accidente cerebrovascular. En: Levine MD, Gilmore WS, editores. Manual Washington de Medicina. Barcelona: Ed Wolters Kluwer; 2018.p 486-91.
32. Amaya Villar R, García Alfaro C. Accidente cerebrovascular agudo. En: Montejo JC, García de Lorenzo A, Marco P, Ortiz C. Manual de Medicina Intensiva. 5ta ed. Barcelona: Elsevier; 2017. p 217-22.
33. Mohanty CS, Ray S, Singhal A. Relationship between Barthel Index (BI) and the Modified Rankin Scale (mRS) Score in Assessing Functional Outcome in Acute Ischemic Stroke. Journal of Marine Medical Society. 2016[acceso: 27/01/2017];18(2):144-9. Disponible en:https://www.marinemedicalsociety.in/temp/JMarMedSoc182144-6766277_184742.pdf
34. Fujita T, Sato A, Yamamoto Y, Yamane K, Otsuki K, Tsuchiya K, et al. Relationship between dressing and motor function in stroke patients: a study with partial correlation analysis. J Phys Ther Sci . 2015[acceso: 17/09/2017];27(12):3771-4. Disponible en: https://www.jstage.jst.go.jp/article/jpts/27/12/27_jpts-2015-632/_pdf
2. Miranda Pérez Y, García Balmaseda A, Breijo Puentes A. Influencia de las lesiones secundarias en el ictus. Rev. Ciencias Médicas de Pinar del Río. 2016[acceso: 21/05/2016];20(1):54-60. Disponible en: https://www.revcmpinar.sld.cu/index.php/publicaciones/article/view-/2435/html_174
3. Smith EE , Saposnik G , Biessels GJ , Doubal FN , Forna M , Gorelick PB , et al. Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke . 2017[acceso: 20/07/2018];48(2):e44-e71. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000116
4. Demaerschalk BM , Kleindorfer DO , Adeoye OM , Demchuk AM , Fugate JE , Grotto JC , et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2016 [acceso: 28/04/2017];47(2):581-641. Disponible en: https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000086-?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub-%3dpubmed
5. Ministerio de Salud Pública. Dirección de Registros Médicos y Estadísticas de Salud 2017. Anuario Estadístico de Salud. 2018. [acceso: 03/08/2018]. Disponible en: https://files.sld.cu/dne/files/2018/04/Anuario-Electronico-Espa%C3%B1ol-2017-ed-2018.pdf
6. Garrote M, Lovesio C. Ataque cerebral o accidente cerebrovascular isquémico. En:
Lovesio C, editor. Medicina Intensiva. 6ta Edición. Rosario: Ed. Corpus; 2008. p.1163-1203.
7. Nakao S, Takata S, Vemura H, Kashihara M, Osawa T, Komatsu K, et al. Relation between Barthel index score during the acute phase of rehabilitation and subsecuent ADL in stroke patient. The Journal of Medical Investigation. 2010 [acceso: 20/02/2016];57(1-2):81-8. Disponible en: https://www.researchgate.net/profile/Hirokazu_Uemura/publication/-42345331_Relationship_between_Barthel_-Index_scores_during_the_acute_phase_of_rehabilitation_and-_subsequent_ADL_in_stroke_patients/links/02bfe-513fbe1134ead000000/Relationship-between-Barthel-Index-scores-during-the-acute-phase-of-rehabilitation-and-subsequent-ADL-in-stroke-patients.pdf
8. Tacconi J, Tafurelli D, Negri M, Keller L, Aranalde GI. Neurología. En: Bartolomei S, Aranalde G, Keller L, editores. Manual de Medicina Interna: cálculos, scores y abordajes. 2da ed. Rosario: editorial Corpus Libros Médicos y Científicos; 2010. p. 685-97
9. Molina Nieto T, Calvo Rodríguez R, Ochoa Sepúlveda JJ, Jiménez Murillo L, Castilla Camacho S, Montero Pérez FJ, et al. Accidente cerebrovascular. En: Jiménez Murillo L, Montero Pérez FJ, editores. Medicina de urgencias y emergencias. Guía diagnóstica y protocolos de actuación. 5ta ed. Barcelona: Editorial Elsevier; 2015.p 387-96
10. Piloto González R, Herrera Miranda GL, Ramos Águila Y, Mujica González DB, Gutiérrez Pérez M. Caracterización clínica-epidemiológica de la enfermedad cerebrovascular en el adulto mayor. Rev. Ciencias Médicas Pinar del Río. 2015 [acceso: 10/12/2015];19(6):[aprox. 10 p.]. Disponible en: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/231-6/html_146
11. Powers WJ, Jordan D. Cerebrovascular Disease. Neurologic Disorders. In: Hall JB, Schmidt GA, Kress JP, editors. Principles of critical care. 4th ed. New York: McGraw-Hill Companies, Inc.; 2015. p 770-8
12. Synhaeve NE, Arntz RM, Noortje A, Maaijwee M, Loes CA, Rutten-Jacobs HC, et al. Poor Long-Term Functional Outcome After Stroke Among Adults Aged 18 to 50 years. Stroke. 2014[acceso: 25/03/2015];45(4):1157-60. Disponible en: https://www.ahajournals.org/doi/full/10.1161/strokeaha.113.004411
13. Cayuela A, Cayuela L, Escudero-Martínez I, Rodríguez-Dominguez S, González A, Moniche F, et al. Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en España 1980-2011. Neurología. 2016[acceso: 21/03/2017]; 31(6):370-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S0213485314001790
14. Sodhi K , Singla MK , Shrivastava A , Bansal N . Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit.Indian J Crit Care Med. 2014[acceso: 17/06/2016];18(12):789-95. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271278/
15. Tripathy S. Geriatric Critical Care in India. Indian J Crit Care Med. 2015 [acceso: 15/09/2016];19(3):191-2. Disponible en: https://www.researchgate.net/profile/Swagata_Tripathy4/publication/-274093157_Geriatric_Critical_-Care_in_India/links/56580bf408aeafc2aac121ab/Geriatric-Critical-Care-in-India
16. Rundek T, Brown DL. Socioeconomic Status and Subclinical Atherosclerosis. Stroke.
2014[acceso: 19/07/2016];45(4):948-9. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/strokeaha.114.004829
17. Dávila Cabo de Villa A. Anestesia en el anciano. 2da ed. La Habana: Editorial Ciencias Médicas; 2015.
18. Barnett HJM. Four Decades of Stroke Prevention Trials. Stroke. 2014 [acceso: 28/03/2016];45(4):e59-e62. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/strokeaha.113.002251
19. Escobar Alfonso V, Zaldívar Garit M, Rodríguez de la Rosa G, Cabrera Cordobés JC. Factores de riesgos prevalentes en pacientes ingresados por enfermedad cerebrovascular. Rev. Cub Med Mil. 2014 [acceso: 23/10/2015];43(4):[aprox. 9 pant.]. Disponible en: https://scielo.sld.cu/scielo.php? script=sci_arttext&pid=S0138-65572014000400003
20. Díaz Alfonso H, Sparis Tejido M, Carbó Rodríguez HL. Ictus isquémico en pacientes hospitalizados con 50 años o más. Rev. de Ciencias Médicas de Pinar del Río. 2015 [acceso: 18/01/2016];19(6):[aprox. 8 pant.]. Disponible en: https://www.revcmpinar.sld.cu/index.php/publicaciones/article/view/-2303/html_152
21. Gorelick PB, Goldstein LB, Ovbiagele B. New Guidelines to Reduce Risk of Atherosclerotic Cardiovascular Disease. Implications for Stroke Prevention in 2014. Stroke. 2014 [acceso: 05/02/2016];45(4):945-7. Disponible en: https://stroke.ahajournals.org/content/45/4/945
22. Strachinariu RT. The role of endothelial dysfunction in the pathogenesis of vascular complications of diabetes mellitus - a high priority area of investigation. Rom J Diabetes Nutr Metab Dis. 2015[acceso: 06/02/2016].22(1):61-6. Disponible en: https://www.degruyter.com/downloadpdf/j/rjdnmd.2015.22.issue-1/rjdnmd-2015-0008/rjdnmd-2015-0008.xml
23. Smith WS, Johnston SC, Claude Hemphill JC. Enfermedades cerebrovasculares. En: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editores. Harrison. Principios de Medicina Interna. Vol. 2. 19ª ed. México DF: McGraw-Hill Interamericana; 2015. p 2559-86.
24. Claude Hemphill J, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2015[acceso: 15/02/2016];46:2032-60. Disponible en: https://stroke.ahajournals.org/content/46/7/2032.full
25. Iglesias Mohedano AM, García Pastor A, Villanueva Osorio JA, Gil Núñez AC. Protocolos de práctica asistencial: Protocolo de atención del ictus en Urgencias. Medicine-Programa de Formación Médica Continuada Acreditado. 2015[acceso: 07/03/2016];11(89):5337-42. Disponible en: https://www.sciencedirect.com/science/article/pii/S0304541215002875
26. Vila García LO, Hernández Pedroso W, Castillo López B, Ramos Ravelo D, Lemer Rodríguez A, Santana Sánchez R. Caracterización de los factores modificables asociados a la letalidad hospitalaria del ictus. Rev. Cub Med Mil. 2017 [acceso: 03/06/2018];46(2):160-73. Disponible en: https://www.revmedmilitar.sld.cu/index.php/mil/article/view/37/52
27. Pérez García AR, García Montero A, Sosa Acosta EF, Padrón Valdés F. Factores pronósticos de mortalidad por hemorragia intracerebral en el periodo agudo. Rev. Cub Med Mil. 2015[acceso: 03/03/2016];44(3):[aprox. 11 p.]. Disponible en:https://scielo.sld.cu/scielo.php?pid=S0138-65572015000300002&script=sci_arttext&tlng=pt
28. Heldner MR, Zubler C, Mattle HP , Schroth G , Weck A , Mono ML, et al. Utility of National Institutes of Health Stroke Scale. Stroke. 2013[acceso: 20/11/2014]; 44(4):1153-7. Disponible en: https://www.ahajournals.org/doi/full/10.1161/strokeaha.111.000604
29. Heiss WD, Kidwell CS. Imaging for Prediction of Functional Outcome and Assessment of Recovery in Ischemic Stroke. Stroke. 2014[acceso: 30/10/2015];45(4):1195-201. Disponible en: https://www.ahajournals.org/doi/full/10.1161/strokeaha.113.003611
30. Pozo Rivero A, Fernández Lora F, Fernández Lora L. Repercusión de factores clínico epidemiológicos sobre el pronóstico de las hemorragias intraparenquimatosas. Medisan. 2010[acceso: 11/07/2011];14(6):747-53. Disponible en: https://www.bvs.sld.cu/revistas/san/vol_14_6_10/san02610.pdf
31. Heitsch L, Panagos P, Morkos El Hayek S. Urgencias neurológicas. Accidente cerebrovascular. En: Levine MD, Gilmore WS, editores. Manual Washington de Medicina. Barcelona: Ed Wolters Kluwer; 2018.p 486-91.
32. Amaya Villar R, García Alfaro C. Accidente cerebrovascular agudo. En: Montejo JC, García de Lorenzo A, Marco P, Ortiz C. Manual de Medicina Intensiva. 5ta ed. Barcelona: Elsevier; 2017. p 217-22.
33. Mohanty CS, Ray S, Singhal A. Relationship between Barthel Index (BI) and the Modified Rankin Scale (mRS) Score in Assessing Functional Outcome in Acute Ischemic Stroke. Journal of Marine Medical Society. 2016[acceso: 27/01/2017];18(2):144-9. Disponible en:https://www.marinemedicalsociety.in/temp/JMarMedSoc182144-6766277_184742.pdf
34. Fujita T, Sato A, Yamamoto Y, Yamane K, Otsuki K, Tsuchiya K, et al. Relationship between dressing and motor function in stroke patients: a study with partial correlation analysis. J Phys Ther Sci . 2015[acceso: 17/09/2017];27(12):3771-4. Disponible en: https://www.jstage.jst.go.jp/article/jpts/27/12/27_jpts-2015-632/_pdf
Published
2020-08-02
How to Cite
1.
Venegas Rodríguez R, Hernández Pedroso W, Chacón Montano D, González Mesana R, Santana Sánchez R, Chibás Ponce E. Stroke in geriatric patients admitted to the intermediate care of internal medicine. Rev Cubana Med Milit [Internet]. 2020 Aug. 2 [cited 2025 Mar. 14];49(3):e0200580. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/580
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