Dissertations / Theses on the topic 'Cerebrovascular Accident'
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1
Cecchini, Arthur, Amanda Cecchini, Clayton McGill, and Christopher Cook. "Cerebrovascular Accident, Cervical Myelopathy, or Both?" Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/58.
Abstract:
Cerebrovascular accidents are a leading cause of morbidity and mortality in the United States. Many conditions exist which may mimic this disease process including seizures, migraines, metabolic derangements, infections, space-occupying lesions, neurodegenerative disorders, peripheral neuropathy, cervical myelopathy, syncope, other vascular disorders, and functional neurologic disorder. Timely diagnosis and treatment are important in order to preserve functional status in these patients. A 48-year-old male presented to the emergency department with a 28-hour history of worsening left sided numbness, tingling, weakness, and feeling off balance. The patient stated that for the past several months he had noticed these symptoms, but they suddenly became worse the day prior. He also described shooting pains down the left arm with certain movements of his neck. The patient denied any difficulty with speaking, understanding words, performing mental tasks, bowel or bladder incontinence, or right sided symptoms. Physical exam showed intact cranial nerves II-XII, 5/5 strength of upper and lower extremities on the right side, 4/5 strength of upper and lower extremities on the left side. Romberg test was normal, heel to shin and finger to nose were intact bilaterally. Foot drop was noted on the left side and placement of the foot on the ground was noted to be clumsy. Initial head CT in the emergency department showed a frontal lobe hypodensity and was without intracranial hemorrhage. Computed tomography angiography of the head and neck showed no large vessel thrombosis or stenosis. Echocardiography revealed normal chamber sizes, normal left ventricular ejection fraction, no patent foramen ovale, and no left atrial or left ventricular thrombus. Telemetry monitoring throughout the stay remained sinus rhythm. Magnetic resonance imaging of brain and cervical spine was performed showing multifocal acute infarcts of the right and left frontal lobes and severe cervical spondylosis at C4-C6 with spinal cord edema in T2 sequences slightly below that level. The patient subsequently underwent a cervical spine decompression for the spinal cord compression during the hospital stay. Due to the multifocal lesions noted on the brain MRI, a vasculitis workup was performed which returned negative for any abnormal test findings. The patient was also diagnosed with diabetes mellitus type 2 during the stay as he was found to have a glycosylated hemoglobin A1C of >12. He was initially hypertensive during hospitalization, but this resolved on its own after day three of the hospitalization so anti-hypertensives were not required. The patient was discharged home on high intensity statin therapy, dual oral hypoglycemic therapy for his diabetes mellitus, home physical therapy, and he was scheduled to start dual antiplatelet therapy seven days after cervical spine surgery. This dual antiplatelet therapy with clopidogrel and aspirin was to be continued for three weeks after which continuation with low dose aspirin was advised. As seen in this case, patients that present with a cerebrovascular accident should always be evaluated for other etiology behind his or her symptoms and having a low threshold for pursing other additional diagnoses is reasonable.
2
Thompson, S. B. N. "A stochastic model of cerebrovascular accident prognosis." Thesis, University of Portsmouth, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380264.
3
Stavric, Verna. "Muscle power after stroke a thesis submitted to Auckland University of Technology in partial fulfilment of the requirements for the degree of Master of Health Science (MHSc), 2007 /." ScholarlyCommons@AUT : Muscle power after stroke, 2007. http://aut.researchgateway.ac.nz/handle/10292/131.
4
Brogårdh, Christina. "Constraint Induced Movement Therapy : influence of restraint and type of training on performance and on brain plasticity /." Umeå : Samhällsmedicin och rehabilitering Community Medicine and Rehabilitation, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-763.
5
Ahmed, Niaz. "Blood pressure in acute ischaemic stroke : blood pressure and stress in the acute phase of stroke and influence of initial blood pressure on stroke-outcome /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-700-2/.
6
Laska, Ann Charlotte. "Aphasia in acute stroke /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-195-1/.
7
Thacker, Joanne Elizabeth. "Patients' understanding and experience of trauma following a cerebrovascular accident." Thesis, University of Birmingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434705.
Abstract:
There is growing evidence to suggest that post-traumatic stress disorder (PTSD) can occur in a minority of people after an acute life-threatening illness such as myocardial infarction (MI), cardiac arrest (CA), cerebrovascular accident (CVA) and haemorrhage. To date, there has been no attempt to link these research findings with psychological models of PTSD. The purpose of this literature review was to investigate whether Ehlers and Clark's cognitive model (2000) is a useful framework for conceptual ising illness-related PTSD. The introduction describes the search strategy used, the diagnostic criteria for PTSD and the prevalence of illness-related PTSD. Ehlers and Clark's cognitive model of PTSD (2000) is outlined and the rationale for using this particular model is explained. The relationships between each component of the model are then discussed with regard to the illness-related PTSD literature and the evidence to support the use of the cognitive model within a medical population is critically evaluated throughout. Methodological limitations are discussed as they arise, with common problems being discussed more fully at the end. A small modification to the model is proposed, to account for the impact of medical symptoms on the PTSD experience. Finally, the clinical implications of the review are discussed.
8
Cecchini, Amanda, Arthur A. Cecchini, and Martin Litman. "Hemiplegic Migraine Presenting as Acute Cerebrovascular Accident: A Difficult Differentiation." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/44.
Abstract:
Cerebrovascular accidents (CVAs) are a leading cause of morbidity and mortality in the United States. Metabolic derangements such as hypoglycemia, infections, brain masses or lesions, neurodegenerative disorders, neuropathies, myelopathies, seizures, syncope, types of migraines, and many other disorders may mimic CVA. Our case presents a 38-year-old female who was evaluated in the emergency department with a three- hour history of headache, lethargy, left- sided upper extremity weakness, facial droop, and dysarthria. A CVA workup was initiated and she immediately underwent a computed tomography (CT) scan of the head which revealed no intracranial hemorrhage. She was unable to provide a thorough medical history due to lethargy, however she was able to answer yes/no questions to screen for tissue plasminogen activator (tPA) qualification. She qualified based on her screening results and was administered tPA for her presumed ischemic CVA. She was then monitored in the intensive care unit for twenty-four hours. Due to reoccurrence of headache and left-sided weakness, as well as recent administration of tPA increasing risk of hemorrhage, she underwent two subsequent negative non- contrast head CT scans to rule out bleeding during that time. On hospital day two, magnetic resonance imaging (MRI) of the head, neck, and spine were performed which were also negative for infarct or hemorrhage. A more detailed history from our patient revealed previous migraine headaches, but her left sided weakness and dysarthria were new symptoms. With this information, it was suspected that she was suffering from a hemiplegic migraine, a rare mimic of CVA. Prochlorperazine, diphenhydramine, valproic acid, and corticosteroids were administered for migraine treatment, which aborted her symptoms entirely. Topiramate was then started for migraine prophylaxis. Daily low-dose aspirin was also initiated due to inability to fully rule out CVA/transient ischemic attack (TIA). An outpatient neurology follow up was scheduled on discharge. In clinical practice, hemiplegic migraines and CVA/TIA may be difficult to differentiate as symptoms often overlap. A detailed history and physical exam with careful attention to associated symptoms and timing of symptom onset is essential to formulating a correct diagnosis. This must be done quickly, as tPA is a high-risk medication with a narrow time window for administration. In conclusion, not all disease processes have an available “gold standard” diagnostic test to differentiate similar diagnoses. MRI of the brain is usually performed to differentiate ischemic CVA from TIA; however, imaging is not useful to differentiate hemiplegic migraine from TIA. Therefore, performing a thorough history, physical exam, and chart review is paramount to provide patients with the correct treatment as well as prevent adverse outcomes. It is the responsibility of the clinician to make difficult decisions weighing the risks and benefits of providing various treatments or interventions, and to know the complications of those treatments. Disease processes mimicking CVA must be considered in all patients, as treating an incorrect diagnosis can have devastating effects.
9
LeRoy, James Allan. "Family affective response to right vs left hemisphere cerebrovascular accident." Diss., The University of Arizona, 1990. http://hdl.handle.net/10150/185179.
Abstract:
Little research has been conducted investigating family affective response to cerebrovascular accidents. This study examines the emotional sequelae suffered by the spouses and adult children of stroke victims along the dimensions of depression, loneliness, and locus of control. Subjects were classified into groups consisting of spouses of individuals suffering right hemisphere cerebrovascular accidents, adult children of right hemisphere stroke patients, spouses of patients suffering left hemisphere cerebrovascular accidents, and adult children of left hemisphere stroke patients. All subjects were administered the Beck Depression Inventory, the Rotter Internal-External Locus of Control Scale, the Fundamental Interpersonal Relations Orientation-Behavior Scale and the UCLA Loneliness Scale. Results indicate no significant differences in levels of depression between spouses, children, or family members of right hemisphere stroke patients as compared to family members of individuals suffering left hemisphere cerebrovascular accidents. Similarly, no differences in loneliness scores were found between spouses and adult children in right versus left hemisphere groups. There also were no differences between groups along the dimensions of wanted control, expressed control, or locus of control. Finally, there were no differences between spouses in either group in terms of wanted affection. The lack of significant differences between groups is felt to be related to a number of factors. Data were collected two to four weeks post-stroke, and it is believed that family members may still have been in the denial phase of the adjustment process. Also, they may have been engaging in "selective gating" (i.e., they may have been processing the positive, encouraging feedback presented by staff and filtering the negative feedback). Additionally, family members (particularly spouses) received much social support during the acute phase of the illness which may have mitigated affective responses. The above, along with the fact that family members may not have had realistic expectations concerning the amount of care the stroke victim would require and the alteration in lifestyle that often occurs may have combined to ameliorate the family emotional response to cerebrovascular accident.
10
Medin, Jennie. "Stroke among people of working age : from a public health and working life perspective /." Linköping : Univ, 2006. http://www.bibl.liu.se/liupubl/disp/disp2006/med930s.pdf.
11
Koch, Lena von. "Early supported hospital discharge and continued rehabilitation at home after stroke /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4027-4/.
12
Sonde, Lars. "Rehabilitation after stroke : effects of length of stay and treatments to facilitate motor recovery after stroke /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4730-9/.
13
Cvetkovic, ́. Jasmina. "Immune mechanisms in atherosclerotic vascular disease /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-268-X.
14
Appelros, Peter. "Stroke severity and outcome : in search of predictors using a population-based strategy /." Stockholm : [Karolinska institutets bibl.], 2002. http://diss.kib.ki.se/2002/91-7349-275-2/.
15
Magnuson, Scott A. "THE EFFECTS OF CEREBROVASCULAR ACCIDENTS ON PROSPECTIVE MEMORY." Wright State University Professional Psychology Program / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=wsupsych1372205700.
16
DiRocco, Dianne Boyer. "The effect of critical pathways on length of stay for cerebrovascular accident patients." FIU Digital Commons, 1995. http://digitalcommons.fiu.edu/etd/2823.
Abstract:
The purpose of this study was to (a) determine the effect of a critical pathway on the length of hospital stay for patients diagnosed with cerebrovascular accident, and (b) identify the variances associated with delayed length of stay for patients admitted after the implementation of the critical pathway. The sample included 34 patients (Male = 14; Female = 20) diagnosed with either hemorrhagic cerebrovascular (n = 4) or non-hemorrhagic (n = 30) accidents. The mean age was 68 years. A t-test comparing the length of stay for patients admitted to the hospital before (Mean = 8.59, SD = 4.95) and after the implementation of the critical pathway (Mean = 8.71, SD = 3.18) indicate that the critical pathway did not reduce the length of stay, t(32) = -.08, p > .05. Variances associated with extended length of stay for patients admitted after the implementation of the critical pathway included delays in discharge due to patient (23.5%), placement (17.6%), and provider (11.8%).
17
Leroux, Tony. "Behavioral and electrophysiological study of binaural hearing in patients with unilateral cerebrovascular accident." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape7/PQDD_0012/NQ42796.pdf.
18
Leroux, Tony (Tony Daniel) Carleton University Dissertation Psychology. "Behavioral and electrophysiological study of binaural hearing in patients with unilateral cerebrovascular accident." Ottawa, 1999.
19
Kouwenhoven, Mathilde Cornelia Maria. "Matrix-degrading metalloproteinases and cytokines in multiple sclerosis and ischemic stroke /." Stockholm : Karolinska Univ. Press, 2001. http://diss.kib.ki.se/2001/91-7349-021-0/.
20
Мудренко, Ірина Григорівна, Ирина Григорьевна Мудренко, Iryna Hryhorivna Mudrenko, Оксана Іванівна Коленко, Оксана Ивановна Коленко, and Oksana Ivanivna Kolenko. "Anxiety-depressive disorders in patients with dysarthria against the background of organic brain damage." Thesis, Cambridge University Press, 2021. https://essuir.sumdu.edu.ua/handle/123456789/87558.
Abstract:
The presence of acquired speech disorders of varying evidence can cause maladjustment and job loss. Often there is no adequate psychological and psychotherapeutic assistance for these patients, which hinders the process of recovery and reintegration into the social environment.
21
Boivie, Patrik. "Cerebrovascular accidents associated with aortic manipulation during cardiac surgery." Doctoral thesis, Umeå : Kirurgisk och perioperativ vetenskap, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-628.
22
Kim, Helen. "Genetic susceptibility to early-onset stroke in young adults /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/10924.
23
Crary, Michael A. "Dysphagia and nutritional status following stroke." [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0008951.
Abstract:
Thesis (M.S.)--University of Florida, 2004.Typescript. Title from title page of source document. Document formatted into pages; contains 44 pages. Includes Vita. Includes bibliographical references.
24
Larson, Jenny. "Life situation after stroke : the spouses' perspective /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-457-0/.
25
Hossain, Mohammed Jamil. "To investigate the need for palliative care in cerebrovascular accident (stroke) patients at Ladysmith Provincial hospital." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20429.
Abstract:
This research study explores the need for palliative care by the patients who are recovering from stroke after an acute event. Stroke survivors need comprehensive care for their physical, psychosocial, spiritual well-being and additional support. The comprehensive total care in all aspect of physical, social and spiritual well-being can only be offered by the holistic approach of palliative care focusing, as it does, on the rehabilitation for stroke survivors to improve their quality of life. A literature review was conducted to investigate how palliative care can help to change the quality of life for stroke survivors. There has been little research on the topic of providing palliative care to stroke patients in South Africa. This research study explores the need and understanding of palliative care management for a stroke survival. The aim of the study is: "To investigate the Need for Palliative care in Cerebrovascular Accident (stroke) patients at Ladysmith Regional Hospital". The objectives of the study were: 1. To identify the holistic care needs of stroke patients. 2. To describe the care provided to stroke patients. 3. To identify the gaps in the care requirements of stroke patients. The study site was Ladysmith Regional Hospital, in UThukela District in Kwa-Zulu-Natal province, South Africa. This is a cross sectional study using mixed methods-both quantitative and qualitative-interviewing patients, and family members of patients who had suffered from a cerebrovascular accident.
26
Thorsén, Ann-Mari. "Five-year follow-up of a randomized controlled trial of early supported discharge and continued rehabilitation at home after stroke /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-543-7/.
27
Lucareli, Paulo Roberto Garcia. "Análise cinemática da articulação do joelho durante a marcha hemiparética." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-14102014-112624/.
Abstract:
Ainda não há consenso entre os diversos estudiosos do tema sobre as variáveis cinemáticas das articulações durante a marcha hemiparética e uma das articulações mais discutidas é o joelho: como as principais alterações se comportam ao longo do ciclo de marcha e se a velocidade da marcha modifica os padrões de mobilidade das articulações. O objetivo deste estudo foi avaliar as variáveis encontradas na cinemática angular da articulação do joelho e descrever as alterações encontradas na marcha hemiparética oriunda de acidente vascular cerebral. Participaram deste estudo 66 pacientes adultos de ambos os sexos com diagnóstico de seqüela de acidente vascular cerebral isquêmico com hemiparesia direita ou esquerda. Todos os participantes foram submetidos a avaliação tridimensional da marcha com o sistema Vicon 370 e os valores da cinemática angular da articulação do joelho foram selecionados para análise. Os resultados foram distribuídos em quatro grupos formados de acordo com a mediana da velocidade de marcha e lado do acometimento. As características clínicas relevantes encontradas e que devem ser levadas em consideração no momento da escolha da melhor conduta de tratamento demonstram no apoio alteração importante no mecanismo de resposta a carga e hiperextensão do joelho no apoio simples. Na fase de balanço redução do pico de flexão e amplitude de movimento do joelho. Há semelhança na cinemática angular da articulação do joelho durante a marcha hemiparética oriunda de acidente vascular cerebral, mas, não foi encontrado um padrão definido para esta articulação na população avaliadaThere is still no consensus among the different specialists on this subject on the kinematics variation during the hemiparetic gait, and one of the most frequently discussed joints is the knee: the way the main changes take place during the gait cycle, and whether the gait velocity changes the patterns of joint mobility. This study aims at evaluating the variables found in the angular kinematics of the knee articulation and at describing the alteration found in the hemiparetic gait resulting from cerebrovascular accident. This study comprised 66 adult patients, both gender with diagnosis of a sequel resulting from ischemical cerebrovascular accident with both right and left hemiparesis. All the participants were submitted to three-dimensional gait evaluation with Vicon 370 and the values of the angular kinematics of the joint knee were selected for analysis. The results were distributed in four groups formed in agreement with the medium of the gait speed and side taken. The clinical relevant characteristics found and that should be taken into account when choosing the best treatment demonstrate, in the stance, an important mechanism of loading response and, in the simple stance, knee hyperextension. In the swing phase, reduction of the peak flexion and movement amplitude of the knee. We believe that our findings presented here may aid the conduct when facing these patients in the sense of preventing the occurrence of problems found, and also in the attempt of finding the origin of these problems
28
Cintra, Eliane de Araujo. "Niveis de arginina vasopressina e disturbios de sodio e agua em pacientes com lesão cerebral grave." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313566.
Abstract:
Orientadores: Sebastião Araujo, Elizabeth M. A. B. QuagliatoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-08T16:17:15Z (GMT). No. of bitstreams: 1 Cintra_ElianedeAraujo_D.pdf: 2161451 bytes, checksum: e8e2d3f8af228c6c474ae97885cb6d9a (MD5) Previous issue date: 2006
Resumo: Antecedentes. Desordens do balanço de sódio e água, especialmente aqueles secundários ao diabete insípido (DI), à síndrome da secreção inapropriada do hormônio anti-diurético (SIHAD) e à síndrome cerebral perdedora de sal (SCPS), são freqüentemente vistas em pacientes com lesão cerebral grave (LCG), tanto traumática quanto não-traumática, podendo comprometer seus prognósticos. Diversos autores têm sugerido que um aumento na secreção de vasopressina (AVP) pode ser responsável pela piora da lesão cerebral primária uma vez que ela afeta os mecanismos cerebrais de formação de edema. Contudo, as alterações fisiopatológicas anteriormente citadas continuam sendo focos de debates na literatura. Objetivo. Avaliar o comportamento dos níveis plasmáticos de vasopressina e a presença de desordens do balanço de sódio e água em pacientes com LCG. Desenho. Estudo prospectivo, observacional e aberto. Local. Unidade de terapia intensiva geral de adultos do Hospital das Clínicas da Universidade Estadual de Campinas. Pacientes e Métodos. Trinta e sete pacientes adultos, de ambos os sexos, com LCG (pontuação inicial na escala de coma de Glasgow ? 8) e tempo estimado de lesão ? 72 horas foram estudados. Dados clínicos e laboratoriais de interesse foram registrados e a AVP foi mensurada em amostras de sangue venoso colhidas no 1o, 2o, 3o e 5o dias após a inclusão. Dados laboratoriais de 29 voluntários adultos sadios, previamente relatados, serviram de controle (CTRL). Resultados. Os níveis plasmáticos médios de AVP permaneceram dentro da faixa de normalidade nos pacientes com LCG, sem diferenças significativas em relação ao grupo controle, mas mostraram-se proporcionalmente menores no 5o dia comparado ao 1o dia após a inclusão (1,5 ± 1,6pg/ml vs 2,3 ± 2,8pg/ml; p = 0,035). Os níveis plasmáticos de AVP foram ligeiramente maiores nos pacientes que evoluíram para o óbito em relação aos sobreviventes (p = 0,062), e mostraram uma queda do 1o em relação ao 5o dia de observação em ambos os grupos (p = 0,049). O sódio sérico e a osmolalidade plasmática, assim como suas variações em relação à faixa de normalidade, foram maiores nos pacientes que evoluíram para o óbito em relação aos sobreviventes (p < 0,05). Conclusão. Os níveis plasmáticos de AVP permaneceram dentro da faixa de normalidade nos pacientes com LCG, e estes tenderam a diminuir com o tempo de evolução, tanto nos sobreviventes quanto nos que evoluíram para o óbito. Contudo, o sódio sérico e a osmolalidade plasmática mostraram grandes variações nos pacientes com LCG, e os não sobreviventes apresentaram desvios mais amplos e mais significativos em relação à faixa de normalidade que os sobreviventes, especialmente hipernatremia e hiperosmolalidade, compatíveis com a presença de disfunção do eixo hipotálamo-hipófisário posterior, principalmente diabete insípido. Contudo, estes resultados não nos permitem afirmar com segurança se esses distúrbios atuaram como agravantes da lesão primária ou se meramente foram um reflexo da gravidade da injúria cerebral
Abstract: Background. Disorders of sodium and water balance, especially those secondary to diabetes insipidus (DI), syndrome of inappropriate anti-diuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS), are frequently seen in patients with severe brain injury (SBI), either traumatic or non-traumatic, and may jeopardize their prognosis. Many authors have suggested that an increase in vasopressin (AVP) secretion may be responsible for the worsening of primary brain lesion as long as it affects the brain mechanisms of edema formation. However, this remains a focus of debate in the literature. Objective. To evaluate vasopressin plasma levels and sodium and water balance disorders in patients with SBI. Design. Prospective, observational, open label study. Setting. General adult intensive care unit, Hospital de Clínicas, Campinas State University. Patients and Methods. Thirty-seven adult patients, both sexes, with SBI (admission Glasgow Coma Scale score ? 8) and an estimated time of injury ? 72 hours were studied. Clinical and laboratory data were recorded and AVP was measured in venous blood samples collected on the 1st, 2nd, 3rd and 5th days following inclusion. Laboratory data from 29 healthy adult volunteers previously reported served as control. Results. Mean AVP serum levels remained inside the normal range in SBI patients, without significant differences in relation to control group, and were proportionally lower at 5th day compared to 1st day following inclusion (1.5 ± 1.6 pg/ml vs 2.3 ± 2.8 pg/ml; p = 0.035). AVP serum levels were slightly higher in patients who died compared to survivors, but this difference was not significant (p = 0.062), and have shown a decrease from the 1st to 5th day of observation in both groups (p = 0.049). Serum sodium and plasma osmolality, and long as their variability, were greater in non-survivor than in survivor patients (p < 0.05). Conclusion. AVP plasma levels remained within normal range in SBI patients, and these levels tended to decrease over time, both in survivor and non-survivors. However, serum sodium and plasma osmolality have shown great variations in SBI patients, and non-survivor ones have shown greater and more significant deviations from normal values than those who survived, especially hypernatremia and hyperosmolality, consistent with the presence of posterior hypothalamus-hypophysial axis dysfunction, mainly diabetes insipidus. Nevertheless, these results do not allow us to clearly define whether these disturbances aggravate the primary lesion or if they are merely a reflex of the cerebral injury severity
Doutorado
Ciencias Biomedicas
Doutor em Ciências Médicas
29
Connolly, Teresa. "Post Stroke Survivors' Experiences of the First Four Weeks During the Transition Directly Home From the Hospital." Thesis, Boston College, 2014. http://hdl.handle.net/2345/bc-ir:104175.
Abstract:
Thesis advisor: Ellen K. MahoneyPurpose: The purpose of this qualitative descriptive study was to investigate the experiences of post stroke survivors (PSSs) during transition from hospital discharge home during the first four weeks. Background: PSSs describe the transition from hospital to home as an important time in recovery and stress various physical and cognitive concerns early within the recovery period. Research to date fails to adequately reflect PSSs' experiences early after discharge home. This gap in research limits the ability to create interventions for PSSs during this critical time period. Methods/analysis: Semi-structured telephone interviews were conducted with 31 participants, recruited from a large metropolitan hospital in the northeastern United States. The use of in-vivo codes lead to the development of themes that described PSSs' experiences during the four week transitional period. Credibility and transferability of findings were strengthened through memoing, field notes, reflexivity of analysis, member checking, and peer review throughout the analysis process by qualitative experts. Results: The five major themes were: (a) the shock of a stroke interrupting a normal day, (b) transition to an unfamiliar home, (c) experiencing a life riddled with uncertainty, (d) a journey to a new sense of self, and (e) adjusting to a new sense of self. Throughout their journey all PSSs had to cope with uncertainty and adjust to a new sense of self. PSSs that experienced less uncertainty were able to return to their prior daily routine, knew how to prevent another stroke, had a helpful support system, and had frequent follow-up and communication with health care professionals. Conclusion: All PSSs are at risk for complications regardless of stroke severity. To address PSSs complex needs, nurses can provide care beyond symptom management by fostering a dynamic intentional relationship to support recovery. The framework resulting from this study can provide the platform for advanced neuroscience nurses to engage with PSSs to improve their recovery and adjustment to a new sense of self as they transition from hospital to home
Thesis (PhD) — Boston College, 2014
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Philosophy
30
Sommerfeld, Disa. "Body function and activity after acute stroke : physiotherapy perspectives /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-828-9/.
31
Nofziger, Erin J. "The effects of emotional support and physical help on the health of caregivers of stroke survivors." Connect to full-text via OhioLINK ETD Center, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1149001064.
Abstract:
Thesis (M.S.)--Medical University of Ohio, 2006."In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Linda Pierce. Includes abstract. Document formatted into pages: vii, 68 p. Title from title page of PDF document. Title at ETD Web site: The effects of emotional support and physical help on the health of caregivers of persons with stroke. Includes bibliographical references (p. 59-65).
32
Kumlien, Suzanne. "Persons with stroke and their nursing care in nursing homes /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-406-6/.
33
Hergens, Maria-Pia. "Swedish moist snuff and the risk of cardiovascular diseases /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-372-6/.
34
Wetterholm, Robert. "Ultrasound evaluation of atherosclerosis and other cardiovascular sources of cerebral embolism /." Göteborg : Department of Molecular and Clinical Medicine/Clinical Physiology, Institute of Medicine, Sahlgrenska Academy at Göteborg University, 2008. http://hdl.handle.net/2077/9438.
35
Comer, Clinton S. "Cerebral Laterality, Emotion, and Cardiopulmonary Functions: An Investigation of Left and Right CVA Patients." Diss., Virginia Tech, 2014. http://hdl.handle.net/10919/56981.
Abstract:
Stroke, or cerebrovascular accident (CVA), is a prominent cause of long term disability in the United States. It has been evidenced that the outcome of a CVA patient differs as a function of the cerebral hemisphere that is damaged by the stroke, especially in terms of emotional changes. The Right Hemisphere Model of Emotion posits that the right hemisphere is specialized for processing emotional content, regardless of valence. In contrast, the Bi-Hemispheric Model of Emotion posits that each hemisphere has its own emotional specialization. The current experiment tested the competing predictions of the two theoretical perspectives in a mixed sample of left cerebrovascular accident (LCVA) patients and right cerebrovascular accident (RCVA) patients using a Dichotic Listening task and the Affective Auditory Verbal Learning Test (AAVLT). Heart Rate (HR) and Pulse Oxygen Saturation (SpO2) were also recorded as sympathetic measures. It was expected that the predictions of the Bi-Hemispheric Model would be supported. A series of mixed design ANOVAs were used to analyze the data. Results revealed that both groups may have exhibited decreased auditory detection abilities in the ear contralateral to CVA location. Additionally, CVA patients recalled significantly more positive words, than negative or neutral words, and exhibited a significant learning curve. LCVA patients exhibited a recency effect, while RCVA patients exhibited a heightened primacy effect. Findings from HR and SPO2 measures suggested a parasympathetic response to neutral information as well as an impaired sympathetic response to negative information in RCVA patients. Taken together these results lend partial support to the hypotheses drawn from the Bi-Hemispheric Model of Emotion, as evidenced by the diametrically opposite effects in these groups, which appears to reflect opposing cerebral processes.Ph. D.
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Okubo, Paula de Carvalho Macedo Issa. "Detecção de disfagia na fase aguda do acidente vascular cerebral isquêmico. Proposição de conduta baseada na caracterização dos fatores de risco." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/17/17140/tde-11092008-145314/.
Abstract:
A disfagia orofaríngea é uma manifestação comum apresentada na fase aguda do acidente vascular cerebral (AVC). A aspiração decorrente das dificuldades de deglutição é um sintoma que deve ser considerado devido à freqüente presença de pneumonias aspirativas que podem influenciar na recuperação do paciente trazendo complicações ao seu quadro clínico em geral e até mesmo risco de morte. A caracterização clínica precoce das alterações de deglutição pode auxiliar na definição de condutas e evitar a administração de dieta por via oral oferecendo riscos ao paciente. O presente estudo teve por objetivo, propor a via mais segura de alimentação na fase aguda do acidente vascular cerebral isquêmico (AVCI) com o intuito de minimizar complicações, utilizando a escala de AVC proposta pelo \"National Institutes of Health\", o NIHSS e considerando alguns fatores de risco para disfagia na clínica apresentada por estes pacientes, com a formulação de um algoritmo. Para tanto, foram avaliados 50 pacientes internados na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo com diagnóstico de AVCI confirmado, clinicamente, por um médico neurologista, dentro de, no máximo, 48 horas entre o início dos sintomas e a avaliação. Os pacientes foram avaliados desde que se enquadrassem nos critérios propostos, sendo 25 do gênero feminino e 25 do masculino, com idade média de 64,90 anos (variação de 26 a 91 anos). Uma anamnese foi realizada antes da participação do paciente no estudo, para que fosse assegurada a ausência de história de dificuldades de deglutição anteriores ao quadro atual. A avaliação clínica fonoaudiológica foi realizada à beira do leito através de um protocolo constituído por dados de identificação do paciente, data do início dos sintomas, data de entrada no hospital, escore da escala de coma de Glasgow (ECG) e do NIHSS obtidos na avaliação neurológica inicial e no dia da avaliação, fatores de risco para AVC, achados clínicos obtidos na avaliação neurológica do paciente, resultado do exame de imagem (tomografia computadorizada ou ressonância magnética). A segunda parte foi destinada à escala do NIHSS e, por fim, a terceira parte constou da avaliação da deglutição, sendo subdividida em estrutural e funcional. Para a avaliação funcional da deglutição foram utilizadas as consistências alimentares pastosa, líquida e sólida (quando possível, dependendo das condições apresentadas pelo paciente). O volume da oferta também dependeu das possibilidades apresentadas: aqueles pacientes que não ofereciam condições clínicas para a realização da avaliação, como os que se encontravam com intubação orotraqueal, estado de sonolência profunda ou em estado de coma, esta foi contra-indicada. Após a avaliação clínica, com a obtenção dos dados estruturais e funcionais, concluiu-se se a avaliação clínica da deglutição apresentava-se normal ou alterada. A partir de então, era concluído sobre a possibilidade de introdução de dieta por via oral. Para a análise estatística foi utilizado o teste exato de Fisher, verificando a associação entre as variáveis. Para avaliar se o escore do NIHSS caracterizaria um indicador de fator de risco para a disfagia, foi construída a curva ROC visando obter características quanto à sensibilidade e especificidade da escala para este propósito. Os resultados demonstraram que a disfagia é uma manifestação freqüente na fase aguda do AVCI, presente em 32% dos pacientes analisados. A avaliação clínica da deglutição é um método confiável de detecção das dificuldades de deglutição. Entretanto, os fatores preditivos de risco para a função devem ser ponderados, devendo ser considerada a gravidade do quadro, o nível de consciência e a presença de comorbidades pré-existentes. A hipertensão arterial sistêmica (HAS) demonstrou ser o principal fator de risco para o AVC apresentada por 72% dos pacientes, seguida do tabagismo (36%), etilismo (20%) e diabete melito (20%). Gênero e hemisfério cerebral acometido não tiveram associação estatisticamente significante com a presença de disfagia. Idade, NIHSS, ECG, alterações de fala e linguagem e topografia da lesão são fatores preditivos de disfagia apresentando diferenças estatisticamente significantes. Pacientes com lesões em território carotídeo apresentaram maior prevalência quanto à presença de disfagia (58,88%). O NIHSS apresenta alta sensibilidade (88%) e especificidade (85%) para detecção de disfagia considerando 12 como valor de corte para sua existência. A formulação de um algoritmo para detecção de disfagia na fase aguda do AVCI poderá auxiliar na definição de condutas quanto à melhor via de administração da dieta enquanto se aguarda uma avaliação fonoaudiológica especializada.Oropharyngeal Dysphagia is a common manifestation presented in the acute phase of cerebrovascular accident (CVA). The aspiration resulting from the difficulties of deglutition is a symptom that should be considered due to the frequent occurrence of aspirative pneumonia that could influence the patient\'s recovery, causing complications to the general clinical and even the risk of death. The early clinical characterization of deglutition alterations can help to specify the proper behavior and to avoid the prescription of a diet that could offer the patients risks. The present study had as objective to propose the most secure feeding for the patient in the acute phase of the ischemic cerebrovascular accident (ICVA) with the aim to minimize complications, using the CVA scale proposed by the National Institutes of Health (NIHSS) and considering some risk factors of dysphagia in the practice presented by these patients, with the creation of an algorithm. Thus, 50 inpatients were evaluated at the Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo with clinically confirmed ICVA diagnosis by a neurologist, within, at most, 48 hours from the onset of the symptoms and the evaluation. The patients were assessed randomly as long as, in which 25 were women and 25 were men, and 64,90 years old were the average ages (variation from 26 to 91 years old). An anamnesis was carried out before the patient\'s participation in the study, so that the previously absence of the history of deglutition difficulties was ensured. The clinical phonoaudiological assessment was carried out on bed side through a protocol constituted by patients identification data, symptoms onset date, admission date in the hospital, Glasgow Coma Scale (GCS) and NIHSS score obtained in the initial neurological evaluation and in the evaluation\'s day, risk factors for CVA, clinical findings obtained from the patient\'s neurological evaluation, result of the screenings (computed tomography or magnetic resonance imaging). The second part was designed to the NIHSS scale and, the third part was constituted by the clinical deglutition evaluation, subdivided in structural and functional. For the functional deglutition evaluation the pasty, liquid and solid feeding consistencies were used (when possible, depending on the conditions presented by the patient). The volume of the offer also depended on the presented possibilities: those patients who did not present clinical conditions for the evaluation, such as the ones who were with orotraqueal intubation, deep sleep state or coma; it was counter-indicated. After the clinical evaluation, with the structural and functional data obtained, it was concluded whether the clinical deglutition evaluation was normal or altered. Since then, it was concluded the possibility of a diet prescription. For the statistical analysis the Fisher exact test was used to verify the association between variables. To evaluate if the NIHSS score would characterize a risk factor indicator for dysphagia, the curve ROC was built aiming to obtain characteristics related to the sensitivity and specificity of the scale for this purpose. The study allowed us to conclude that dysphagia is a frequent manifestation in the acute phase of ICVA, present in 32% of the analyzed patients. The clinical deglutition evaluation is a reliable method of difficulties deglutition detection. However, the predicting risk factors for the function should be balanced and the severity of the clinical picture, the consciousness level and the presence of preexistent comorbidities should be considered. The systemic arterial hypertension (SAH) demonstrated to be the main risk factor for the CVA presented by 72% of the patients, followed by tabagism (36%), alcoholism (20%) e diabetes mellitus (20%). Gender and damaged cerebral hemisphere did not have a statistically significant association to the presence of dysphagia. Age, NIHSS, GCS, speaking and language alterations and lesion topography are predicting factors of dysphagia presenting statistically significant differences. Patients with lesions in the carotid territory presented more prevalence regards the presence of dysphagia (58,88%). NIHSS presents high sensitivity (88%) and specificity (85%) to the detection of dysphagia considering 12 as the cutoff value for its existence. The creation of an algorithm to detect dysphagia in the acute phase of ICVA will be able to help the definition of the proper behavior regards the prescription of a diet while a specialized speech pathological evaluation is awaited.
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Blane, Alison Louise. "Driving on the brain: An investigation of cerebrovascular accident and driving, and the development of a post-stroke driver profile." Thesis, Curtin University, 2017. http://hdl.handle.net/20.500.11937/56431.
Abstract:
Assessing post-stroke driving safety is a multifactorial issue. Therefore, this thesis developed a post-stroke driver profile, investigating the appropriateness of assessments; including on-road observations, simulated driving and cognitive assessments in licensed post-stroke drivers. It also assessed the influence of post-stroke cognition on driving performance, task demand, and investigated the compensation strategies used by post-stroke licensees. The results are useful for practitioners and policy makers, and in driving assessments, rehabilitation programmes and for future research.
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Rahe, Patricia A. "Self-efficacy perceptions of patients following a cerebral vascular accident before and after participation in a stroke rehabilitation program." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/845965.
Abstract:
The purpose of this study was to determine if the perceived level of ability (self-efficacy) differed from actual performance ability for individuals with cerebral vascular accidents (CVA's). Patients were assessed for perception and actual ability level on Activities of Daily Living (ADL's) and Balance skills at admission and at discharge from an inpatient CVA rehabilitation program. Thirty patients with unilateral brain lesions (15 right and 15 left) constituted the study group. ANOVA and repeated measures were used in this quasi-experimental, quantitative study to examine data. All three research hypotheses were tested at an alpha level of .05 for significance. The first and third research hypotheses were supported: CVA patients' self-efficacy scores on ADL's and Balance Skills were significantly different from actual performance scores at time of admission to a CVA rehabilitation program; and the self-efficacy scores were significantly closer to actual performance scores for ADL skills at discharge. The improved accuracy in perception of Balance Skills was not supported by comparison of scores between admission and discharge measurements. The second hypothesis that right hemisphere CVA lesion patients self-efficacy and actual performance scores would be significantly different compared to the scores of patients with left hemisphere CVA lesions was not supported. A ttest for paired samples was also performed on the ADL scores data to investigate three-way significance for the third hypothesis. The patients studied successfully completed the prescribed therapeutic activities in a CVA rehabilitation program and were able to predict with significantly improved accuracy, performance ability on ADL skills at discharge.School of Nursing
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Björkdahl, Ann. "Stroke rehabilitation : a randomized controlled study in the home setting : functioning and costs /." Göteborg : Institute of Neuroscience and Physiology/Rehabilitation Medicine, The Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/2555.
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Keptner, Karen M. "RISK, FUNCTIONAL OUTCOMES, AND THE UTILIZATION OF REHABILITATION SERVICES AMONG SURVIVORS OF CEREBROVASCULAR ACCIDENT: A POOLED, CROSS-SECTIONAL POPULATION-BASED STUDY." Case Western Reserve University School of Graduate Studies / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1408357376.
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Wanby, Pär W. "On certain genetic and metabolic risk factors for carotid stenosis and stroke /." Linköping : Kalmar : Linköping University ; Department of Internal Medicine, County Hospital of Kalmar, 2006. http://www.bibl.liu.se/liupubl/disp/disp2006/med942s.pdf.
42
Strand, Magnus. "Estrogen signaling in stroke : genetic and experimental studies." Doctoral thesis, Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1397.
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Ehrensperger, Eric 1966. "Predictors of cerebral ischemic events in patients with asymptomatic carotid artery stenosis : systematic review." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111568.
Abstract:
Background. Carotid stenosis is an important cause of stroke. Carotid endarterectomy is a means of reducing the burden of stroke but is of marginal benefit in individuals with asymptomatic carotid stenosis. The identification of factors associated with increased risk of cerebral ischemic events would help select individuals who may obtain a greater benefit.Methods. A comprehensive search was performed to identify studies examining risk factors for cerebral ischemic events in patients with asymptomatic carotid stenosis. Inclusion criteria were defined a priori. Relevant studies were reviewed, assessed for quality, and data were extracted.
Results. Thirty-four studies met the inclusion criteria. There was a suggestion of increasing neurological events with increasing severity and progression of carotid stenosis. There was some evidence for an association with carotid plaque morphology. No consistent association was found with clinical factors, impaired cerebral vasoreactivity, or cerebral embolic signals.
Conclusions. The evidence is insufficient to reliably identify individuals with asymptomatic carotid stenosis who are at a higher risk of cerebral ischemic events.
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Faijerson, Jonas. "Neural stem/progenitor cells in the post-ischemic environment : proliferation, differentiation and neuroprotection /." Göteborg : Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Göteborg University, 2007. http://hdl.handle.net/2077/4516.
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Guelpen, Bethany van. "Folate in cancer and cardiovascular disease : prospective studies from the population-based northern Sweden health and disease study /." Umeå : Umeå University, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-850.
46
Calota, Andra. "Reliability of spasticity measurement based on tonic stretch reflex threshold." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111947.
Abstract:
Studies suggest that deficits in central regulation of stretch reflex thresholds (SRT) underlie both spasticity and other disorders of motor control. We investigated intra- and inter-evaluator reliability to quantify spasticity based on tonic SRT (TSRT) and the relationship between TSRT and Modified Ashworth Scale (MAS, clinical assessment of resistance to stretch). Spasticity was evaluated in 20 subjects with chronic stroke-related spasticity in two different days, by three evaluators. Twenty different velocity-dependent dynamic SRT (angle where biceps brachii EMG signal increased for a given velocity of stretch) were recorded. TSRT (excitability of motoneurons at 0°/sec) was then computed. Spasticity was also estimated with MAS. Reliability was moderately good for subjects with moderately high spasticity (intra--evaluator: 0.46 to 0.68, inter--evaluator: 0.53 to 0.68). There was no correlation between TSRT and MAS since they measure different phenomena. TSRT is a promising new measure of spasticity. Further improvements for its quantification are suggested.
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Subramanian, Sandeep. "Effects of feedback on recovery of pointing movements in two training environments in stroke : a pilot study." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=112364.
Abstract:
Virtual reality environments (VEs) are new tools to improve functional recovery in stroke survivors. Elements essential to maximize motor learning, can be optimized in VEs. Study objectives were: (a) to determine whether training in VE with enhanced feedback about movement patterns, leads to greater gains in arm movement quality, motor performance and decreased compensation compared to training in a similarly designed Physical environment (PE); (b) to estimate whether impairments in cognitive functioning affected the changes observed after training. Twelve stroke survivors practiced 72 pointing movements in VE or PE for 10 sessions with enhanced feedback. Kinematic analysis of pointing task, evaluations of arm impairment and function were carried out pre-post training. After training, VE group had increased shoulder flexion (p<0.05), increased shoulder horizontal adduction and decreased compensation, compared to PE group. Use of feedback correlated with fewer deficits in cognitive functioning. Training in VEs may lead to greater gains in movement quality.
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Ivanova, N. M. "Anxiety-depressive disorders and cognitive impairment in patients with the consequences of transferred acute cerebrovascular accident. features of early diagnosis and treatment." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18744.
49
Wanby, Pär W. "On certain genetic and metabolic risk factors for carotid stenosis and stroke." Doctoral thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7467.
Abstract:
The present study evaluated genetic and metabolic factors influencing the risk of acute cerebrovascular disease (CVD) and internal carotid artery stenosis (ICA stenosis) in a Swedish community. The threonine (T) containing protein of the FABP2 A54T gene polymorphism has a greater affinity for long chain fatty acids (FFAs) than the alanine (A) containing protein. This altered affinity for FFAs has been shown to affect the intestinal absorption of fatty acids and consequently the fatty acid composition of serum lipids, in particularly postprandially. Endothelium derived NO is a potent vasodilator and antiatherogenic agent. Asymmetric dimethyl arginine (ADMA) is an endogenous competitive inhibitor of endothelial nitric oxide synthase (eNOS). ADMA has been shown to be involved in the pathogenesis of atherosclerotic disease, and ADMA inhibits eNOS by displacement of L-arginine from the enzyme, which in turn is believed to affect the amount of NO available within the endothelium. The FABP2 A54T gene polymorphism was analyzed in 407 patients with acute CVD and also in a subset of these patients whose carotids had been evaluated with ultrasound. Both the FABP2 polymorphism and a common polymorphism of the eNOS gene, Glu298Asp, were analyzed in a different population consisting of 54 matched pairs of patients with ICA stenosis and controls. ADMA levels were measured in both study populations. We found that the T54 allele was more frequent in patients with transient ischaemic attacks (TIA), and that the TT genotype was more prevalent in young, non-smoking patients with CVD than in controls. Increased concentrations of ADMA were observed in cardio-embolic infarction and TIA, but not significantly in non-cardio-embolic infarction nor in haemorrhagic stroke. In multivariate logistic regression models, CVD increased across quartiles of ADMA in all subgroups, but this association was only significant in the TIA group. A decreased arginine/ADMA ratio, a measure of NO availability was associated with CVD in the entire study population. Patients with severe carotid stenosis had significantly higher ADMA levels than the controls. Allele and genotype frequencies of the FABP2 and eNOS polymorphisms did not differ between patients with ICA stenosis and controls. Our results indicate that ADMA is a strong marker for TIA and severe ICA stenosis, and that relative defiency of arginine, measured as L-arginine/ADMA, is present in acute CVD. We also conclude that a common polymorphism of the FABP2 gene increases susceptibility to ischaemic stroke and TIA.Figure 4 on page 17 is publshed with kind permisson from The Journal of Physiology (http://jp.physoc.org/).
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Fornari, Luciana Savoy. ""Fibrilação atrial e tratamento antitrombótico em pacientes atendidos em hospital especializado em cardiologia no Brasil"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-13042006-120958/.
Abstract:
Objetivo: Avaliar o uso de antitrombóticos em pacientes com fibrilação atrial (FA) em hospital cardiológico no Brasil (InCor).Métodos e resultados: Um estudo observacional transversal analisou os prontuários de todos os pacientes atendidos no InCor em cada um de 5 dias separados no ano de 2002 (Fase 1), sendo prospectivamente reanalisados após 1 ano (Fase 2). A prevalência da FA nos 3764 prontuários analisados foi de 8%. Antiplaquetários foram prescritos para 21,26% e 19,93%, anticoagulantes para 46,51% e 57,81%, e 32,23% e 22,26% não usavam nenhum antitrombótico nas Fases 1 e 2, respectivamente. Somente 15,60% e 23,25% apresentavam níveis de RNI terapêuticos.Conclusão: A anticoagulação é subutilizada nos pacientes com FA apesar do fato de serem tratados por cardiologistas em um hospital universitárioObjective: To assess antithrombotic therapy among atrial fibrillation (AF) patients in a Brazilian University Heart Hospital (InCor).Methods and results: A cross sectional study analyzed the charts of all patients treated at InCor in 5 separate days of 2002 (Phase 1), and prospectively reviewed them after one year (Phase 2). The prevalence of AF in the 3,764 assessed charts was of 8.0%. Antiplatelets were prescribed to 21.26% and 19.93%, anticoagulants to 46.51% and 57.81%, and 32.23% and 22.26% were not receiving any antithrombotic in Phases 1 and 2, respectively. Only 15.60% and 23.25% were within INR therapeutic range.Conclusion: Anticoagulation is underused in AF patients besides the fact of being treated by cardiologists in a University Hospital