We performed a prospective, controlled study of kinetic therapy in acute, severe stroke. This therapy involved continuous mobilization of a bedridden patient by means of a specially designed rotating bed. All patients with acute stroke presenting to the Neurology Service over an 18-month period were screened, and those that qualified were assigned to confinement in either a routine hospital bed or a rotating bed. We found that the most common complication of stroke with bed confinement of 4 days or longer was bacterial infection consisting of either pneumonia, sepsis, or urinary tract infection. The two variables found to be of greatest significance in affecting the rate of infection were length of bed confinement, especially for > 13 days (2.3-fold increased risk, p<0.04), and placement in a routine hospital bed (2.9-fold increased risk, p = 0.023). (Stroke 1987;18:638-642)
To determine the importance of syphilis testing in cerebrovascular disease, we prospectively assessed 218 consecutive patients with either transient ischemic attack or completed stroke. The results from this study group were compared with those from a control group of 150 neurological patients without cerebrovascular disease. Of 275 patients from both groups specifically tested by the fluorescent treponemal antibody-absorption test, 34% of the study group were seropositive compared with 18% of the controls (^2=7.7, p<0.01). Fifty-four percent of the patients with a positive fluorescent treponemal antibody-absorption test underwent a cerebrospinal fluid examination; meningovascular syphilis was detected in one (0.4%) of these. This patient was a homosexual male with antibodies to the human immunodeficiency virus; a second patient, with possible meningovascular syphilis, also had antibodies to this virus. Despite the relatively high rate of syphilis seropositivity noted in our study group, syphilis was not found to be a common cause of cerebrovascular disease; therefore, routine screening is seen to be of low diagnostic yield. Attention to patients who are at higher risk for syphilitic infection, patients with clinical features suggestive of meningovascular syphilis, and the proper choice of serologic studies can help make the assessment of syphilis seropositivity more clinically appropriate and cost effective. T his study was undertaken to assess the value of testing for syphilitic infection in patients admitted to the hospital with a diagnosis of stroke or transient ischemic attack (TIA) in the 1980s. We have observed that screening for meningovascular syphilis is still done routinely in patients presenting with cerebrovascular disease (CVD) despite the apparent low yield. We thus prospectively assessed the pattern of testing and the results at a large, urban, university-affiliated hospital in Miami, Florida. These results were compared with those from a control group of patients who underwent syphilis screening because of neurologic disorders other than CVD. Subjects and MethodsConsecutive patients with stroke or TIA were assessed prospectively on the Neurology Service at Jackson Memorial Hospital, Miami, Florida, from July 1, 1986, through December 31, 1986. A total of 218 patients were entered, and each patient was screened for syphilis infection by history, review of previous medical records, and examination. These CVD patients were compared with 150 control patients, chosen at random from medical records, Received May 2, 1988; accepted July 26, 1988. who were admitted to the Neurology Service over the same time period, had a neurologic disorder other than CVD, and had had at least one screening test for syphilis. The tests for syphilis included the rapid plasma reagin (RPR), which is a simplified version of the Venereal Disease Research Laboratory (VDRL) test, the serum fluorescent treponemal antibody-absorption (FTA-ABS) test, and the cerebrospinal fluid VDRL (CSF VDRL). The performance and choice of a ...
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