Stroke and Disorders of Consciousness

Dostović, Zikrija; Smajlović, Dževdet; Dostovic, Ernestina; Ibrahimagić, Omer Ć.

doi:10.1155/2012/429108

Cited by 11 publications

(10 citation statements)

References 9 publications

(10 reference statements)

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“…This was in agreement with previous studies [26,30]. However, this was in disagreement with other studies that found delirium was significantly less prevalent in hypertensive patients [18] and smokers [28] and higher among stroke patients with cardiac disease [5].…”

Section: Discussionsupporting

confidence: 74%

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Assessment of the risk factors and functional outcome of delirium in acute stroke

Zaitoun

El-Sayed

Ramadan

2019

Egypt J Neurol Psychiatry Neurosurg

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Background: Post stroke delirium is a multifactorial life-threatening process, still poorly understood. The aim of the study was to identify the risk factors associated with the development of delirium in acute stroke patients and detection of the effect of delirium on the short-term prognosis of acute stroke patients.Patients and methods: This study was carried on 74 acute stroke patients, 40 males (54.1%) and 34 females (45.9%). Full general and neurological examination was performed to all patients. Full routine laboratory investigation and computed tomography scan and/or magnetic resonance imaging of the brain were done. Results: The patients were divided into two groups: 15 patients with delirium (group I) and 59 patients without delirium (group II). The incidence of delirium was higher among patients with older age (P = 0.002). There was no statistically significant relationship between incidence of delirium and sex of patients (P = 0.52). The delirium patients had significantly higher National Institutes of Health Stroke Scale (NIHSS) (P = 0.001) and lower Glasgow Coma Scale (GSC) (P = 0.001) at admission. They also had high mortality (P = 0.017) and lower Barthel Index (BI), and these results were statistically (P = 0.001) significantly. Conclusion: Post stroke delirium was associated with old age, higher NIHSS at admission, intracerebral hemorrhage, and higher long-term mortality.

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Section: Discussionsupporting

confidence: 74%

“…Delirium is a multifactorial neuropsychiatric disorder with definite predisposing and precipitating factor [18] and is one of the most common complications that older patients develop affecting up to 30% of all older medical hospitalized patients [19].…”

Section: Discussionmentioning

confidence: 99%

Assessment of the risk factors and functional outcome of delirium in acute stroke

Zaitoun

El-Sayed

Ramadan

2019

Egypt J Neurol Psychiatry Neurosurg

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“…[1][2][3] An especially challenging clinical conundrum is in the management of patients with disorders of consciousness after brain injury given their inability to participate in crucial neurorehabilitation. [8][9][10] Disorders of consciousness may include minimally conscious or vegetative states that can persist from months to years after the initial insult. [8][9][10] These disorders of consciousness are associated with a high degree of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

A Review of Pharmacologic Neurostimulant Use During Rehabilitation and Recovery After Brain Injury

Kakehi

Tompkins

2021

Ann Pharmacother

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Objective: To describe the efficacy and safety of pharmacologic neurostimulants after neurological injuries such as ischemic or hemorrhagic stroke and traumatic brain injury (TBI), critically evaluate the available literature, and make recommendations regarding which neurostimulants should be considered for use in clinical practice. Data Sources: A literature search of PubMed was performed (1953 to October 2020) to identify relevant articles. Search terms included the following: “neurostimulant, neurorehabilitation” AND “traumatic brain injury, cerebrovascular accident, or stroke.” This review is limited to prospective studies and observational trials. Study Selection and Data Extraction: Relevant English-language studies conducted in humans were considered. Data Synthesis: Cognitive and motor deficits caused by stroke and TBI account for high rates of long-term disability. Although not well-established, pharmacologic agents, broadly characterized as neurostimulants, may be prescribed after brain injury to treat these deficits. When prescribing these medications, it is imperative to be aware of the supporting evidence in order to accurately gauge the risk-benefit profile of each agent. Relevance to Patient Care and Clinical Practice: The following presents a literature review critically evaluating clinical studies that investigate neurostimulant use after brain injury. The intent of this review is to serve as an evidence-based guide for clinicians. Conclusions: The pharmacologic agent with the most supporting literature is amantadine used for cognitive improvement after TBI. Other neurostimulants with positive, despite more limited, evidence include methylphenidate, modafinil, levodopa, and citalopram. Caution is warranted with other neurostimulants given higher rates of adverse effects or lack of benefit observed in clinical trials.

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“…Reduced level of consciousness may also be a direct consequence of strokes particularly of the thalamus or the brainstem [25]. Previous studies found the prevalence of impaired consciousness to range between 5 and 40%, depending on the timing of assessment after stroke [26][27][28][29][30]. Delirium which affects relevant proportions of stroke patients [31], may also impact on language use and hence substantially interfere with successful communication [32].…”

Section: Introductionmentioning

confidence: 99%

Use of analgesics in acute stroke patients with inability to self-report pain: a retrospective cohort study

Schuster¹,

Hoyer²,

Ebert

et al. 2020

BMC Neurol

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Background: Pain is a common and burdensome complication in patients with acute stroke. We assessed the impact of impaired communication in stroke patients on pain assessment and treatment. Methods: We included 909 (507 male, mean age 71.8 years) patients admitted to our stroke unit from 01/2015 to 12/2015 in the analysis. Patients were assigned to four groups: able to communicate (AC), not able to communicate prior to index stroke (P-NAC), due to focal symptoms of index stroke (S-NAC), due to a reduced level of consciousness (C-NAC). Pain prevalence, documentation of pain and use of analgesics were evaluated. C-NAC patients were excluded from analyses regarding analgesic treatment due to relevant differences in patient characteristics. Results: 746 patients (82.1%) were classified as AC, 25 (2.8%) as P-NAC, 90 (9.9%) as S-NAC and 48 (5.3%) as C-NAC. Pain was documented on the Numeric Rating Scale and in form of free text by nurses and physicians. Nurses documented pain more frequently than physicians (p < 0.001). Pain prevalence was 47.0% (n.s. between groups). The use of analgesic medication increased from 48.7% in the AC group, to 76.0% in the P-NAC group, and 77.8% in the S-NAC group (p < 0.001). Opioid use was significantly more frequent in NAC patients (p < 0.001). The response to the treatment was poorly documented with significantly lowest rates in S-NAC patients (p < 0.001). Conclusions: Our study suggests that post-stroke pain in patients with inability to communicate is not attended enough, not systematically assessed and therefore not sufficiently treated.

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Stroke and Disorders of Consciousness

Cited by 11 publications

References 9 publications

Assessment of the risk factors and functional outcome of delirium in acute stroke

Assessment of the risk factors and functional outcome of delirium in acute stroke

A Review of Pharmacologic Neurostimulant Use During Rehabilitation and Recovery After Brain Injury

Use of analgesics in acute stroke patients with inability to self-report pain: a retrospective cohort study

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