Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine screening with videofluoroscopy to detect aspiration is questioned.

We studied the relation of reactive hyperglycemia, stress hormone response, and outcome in 23 consecutive elderly patients (median age 80 [range 75-92] years) following an acute first stroke. The median delay from the onset of the stroke to the first blood sample (day 0) was 9 (range 4-22) hours. Subsequent blood samples were taken, after fasting, for the determination of blood glucose, cortisol, catecholamine, insulin, C-peptide, glucagon, and lactate concentrations on days 1, 2, 3, 7, 14, 30, and 90. For all 23 patients, a significant relation was found between the blood glucose concentration and survival (/?=0.03) and the blood glucose concentration decreased with time (p< 0.001). There was also a significant relation between blood glucose concentration and outcome (p=0.02). For the 15 patients with complete data, the major determinants of the blood glucose concentration were the cortisol, insulin, and glucagon concentrations (allp<0.001), which accounted for 42% of the variance. When all the indexes were analyzed together by logistic regression, only the cortisol concentration was related to outcome (p=0.02). Hyperglycemia following a stroke probably reflects the intensity of the stress hormone response. We have confirmed that hyperglycemia is a predictor of outcome in persons with stroke. (Stroke 1991;22:842-847)

Continuing aspiration may be related to the side of the cerebral lesion.

We have evaluated the Frenchay Aphasia Screening Test (FAST) in an elderly population living in the community, and in patients with a first stroke. Fifty-one elderly people aged 69-90 years were screened. Ten subjects failed the test (score < 25/30). There was an inverse relationship between age and the FAST score ( r s = -0.35, p = 0.02, 95% Cl 0.09-0.57). I n a group of 82 elderly patients, mean age 80 (6 years), admitted with a first stroke, the FAST was applied at one and seven days and the result compared with a clinical assessment and a speech therapy assessment. At day one 28 patients failed the test due to a reduced level of consciousness. The use of the FAST increased the sensitivity of screening from 87% to 96%, but reduced its specificity from 100% to 61 %. The positive and negative predictive values were 65% and 95% respectively.

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