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Biomedical subjects

C S Gray

Publications and source records attributed to C S Gray.

At least 19 recordsLinked to original sources
PubMed1998

Recovery from visuospatial neglect in stroke patients.

OBJECTIVES: To describe the natural recovery of visuospatial neglect in stroke patients and the distribution of errors made on cancellation tests using a standardised neuropsychological test battery. METHOD: A prospective study of acute (< seven days) patients with right hemispheric stroke. Patients identified with visuospatial neglect were followed up for three months with monthly clinical and neuropsychological testing RESULTS: There were 66 patients with acute right hemispheric stroke assessed of whom 27 (40.9%) had evidence of visuospatial neglect. Patients with neglect, on admission, had a mean behavioural inattention test (BIT) score of 56.3, range 10-126 (normal>129). Three of the subtests identified errors being made in both the right and left hemispaces. During follow up, recovery occurred across both hemispaces, maximal in the right hemispace. Recovery from visuospatial neglect was associated with improvement in function as assessed by the Barthel score. At the end of the study period only six (31.5%) patients had persisting evidence of neglect. On admission the best predictor of recovery of visuospatial neglect was the line cancellation test (Spearman's rank correlation r=-0.4217, p=0.028). CONCLUSION: The demonstration of errors in both hemispaces has implications for the theory that neglect is a lateralised attentional problem and is important to recognise in planning the rehabilitation of stroke patients.

Activities of Daily Living↗
PubMed1998

Atrial fibrillation and cognitive function: case-control study.

Atrial fibrillation is an important and independent risk factor for cerebrovascular disease and vascular dementia. There is increasing evidence that atrial fibrillation is associated with an increased risk of asymptomatic or silent cerebral infarction and as a result may confer an increased risk of progressive cognitive impairment on a person. In this study we sought to determine whether this hypothesis could be explored in a prospective case controlled design. Twenty seven patients with non-valvular atrial fibrillation (NVAF) and no history of stroke, transient ischaemic attack, dementia, and thyrotoxicosis were compared with 54 age and sex matched controls in sinus rhythm. All cases underwent clinical examination, ECG, and psychological assessment using a battery of nine neuropsychological tests. Between group analysis and a comparison of mean test scores of paired controls with cases were undertaken. The presence of atrial fibrillation was consistently associated with poorer performances on all the subtests of the neuropsychological battery. There was no association between duration of atrial fibrillation and performance. These results provide evidence to justify further examination of the hypothesis in a larger prospective study to determine whether antithrombotic therapy may protect against cognitive decline in patients at maximal risk of silent cerebral ischaemia and associated cognitive decline.

Aged↗
PubMed1996

Atrial fibrillation and stroke prevention in the community.

Atrial fibrillation (AF) is an important and independent risk factor for stroke, particularly in elderly people. The efficacy of treatment with warfarin and aspirin in primary and secondary stroke prevention in AF has been demonstrated in randomized clinical trials. In a demographic study, we examined the prevalence of AF in patients registered with a general practice in the North East of England; 91 patients with known AF were identified, 69 with chronic AF and 22 with paroxysmal AF. The mean duration of the arrhythmia was 6.43 years and the prevalence of AF increased with age. There was a high prevalence of cerebrovascular disease in AF patients. The majority of AF patients were not receiving therapy with aspirin or warfarin as primary or secondary stroke prevention. If strategies for stroke prevention in AF are to be applied to the community, general practitioners will need to play a more active part.

Aged↗
PubMed1996

Treatment of post-stroke hypertension. A practical guide.

Cerebrovascular disease is a common cause of morbidity and mortality, especially in the elderly. Treatment of hypertension is effective in the primary prevention of stroke. Hypertension is seen in 80% of acute stroke patients but, by the tenth day after admission to hospital, only one-third are still hypertensive. The clinical significance of post-stroke hypertension is uncertain and its management is a contentious issue. In this article we review current evidence regarding the risks and benefits of the treatment of post-stroke hypertension. The pathophysiology of post-stroke hypertension is described in relation to autoregulation of cerebral blood flow after cerebral infarction or haemorrhage. In the absence of clinical trial data, recommendations for early treatment of post-stroke hypertension are based on a review of expert opinion that immediate, controlled lowering of blood pressure after acute stroke is required only in defined situations such as hypertensive encephalopathy or aortic dissection. There are no reliable data regarding the comparative effects of different hypotensive agents after acute stroke; short-acting vasodilator drugs are recommended if treatment is essential. The benefits of hypotensive therapy in secondary prevention of recurrent stroke are uncertain but the results of large clinical trials in progress should provide helpful guidelines for clinical practice.

Antihypertensive Agents↗
PubMed1993

Computerised tomography and stroke.

To evaluate the utilisation of CT diagnostic imaging in patients admitted to hospital with a clinical diagnosis of stroke, and to identify factors which influence the use of CT imaging in stroke. Two hundred and fifty consecutive (155 females) stroke patients were assessed median age 76 years (range 39-95 y). Ninety-seven patients underwent CT scanning; median time to scan from admission was two days (range 0-43). The time to CT scanning was significantly shorter in patients aged < 65 years (p < 0.001), and in patients with a non-disabling stroke (p < 0.05). The factors (odds ratios and 95% confidence limits) significantly associated with CT scanning were male sex (2.21:1.31-3.74); normal Glasgow coma score (2.48:1.59-3.85); Rankin score 1-3 (6.40:1.74-23.56); age < 65 years (10.23:4.49-23.32) and no previous cerebrovascular event (1.97:1.10-3.51). In this study, those patients who would benefit most from medical intervention with antiplatelet agents to reduce the risk of recurrence were more likely to receive CT diagnostic imaging.

Adult↗
PubMed1993

Essential tremor and dystonia.

We reviewed the database of the Dystonia Clinic at the University of Kansas Medical Center for patients with dystonia and tremor. Of 296 patients with idiopathic dystonia, 24 had dystonic tremor, 20 with cervical dystonia had an isolated head-nodding tremor, two patients with writer's cramp had ipsilateral hand tremor, and two patients with generalized dystonia had arm tremor. Eight patients, all with cervical dystonia, had essential tremor that preceded the onset of their dystonia.

Dystonia↗
PubMed1992

Driving in Alzheimer's disease.

OBJECTIVE: To determine if the impaired mental skills in Alzheimer's Disease (AD) may adversely affect driving ability. DESIGN: Retrospective survey. SETTING: The Alzheimer's Clinic of the University of Kansas Medical Center. PATIENTS: We interviewed 67 AD patients and their families and compared them with 100 elderly, non-spousal controls. MEASURES: The questionnaire was designed to obtain information on their driving habits, with emphasis placed on whether they were still driving, and the number of accidents per year for the past 10 years. RESULTS: Forty-six of the AD subjects had stopped driving because of safety concerns expressed by the subjects, their families, or health care providers, and two had stopped for other reasons. Only two of the normal controls had stopped driving (P < 0.0001, Chi-square test). Over the past 3 years, the 19 AD subjects who were still driving had 263.2 motor vehicle accidents per million vehicle miles of travel compared with 14.3 for the controls (P < 0.002, Mann-Whitney U test) and 5.7 for the general driving population age > or = 55 years (P < 0.05, Students one group, two-tailed t test). CONCLUSION: This study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic safety problem.

Accidents, Traffic↗
PubMed1991

Environmental risk factors in siblings with Parkinson's disease.

To investigate possible risk factors in Parkinson's disease, we conducted a case-controlled study of 19 families having two or more siblings with Parkinson's disease. Demographic data were collected, including lifetime histories of places of residence; sources of drinking water; occupations, such as farming; and exposure to herbicides and pesticides. Rural living and drinking well water, but not farming and herbicide exposure, were significantly increased in 38 parkinsonians compared with 38 normal control subjects. A comparison of parkinsonian siblings with siblings with essential tremor revealed no differences in any risk factors for the years of shared environment. These data suggest that living in a rural environment and drinking well water are risk factors for Parkinson's disease and that the total life exposure to an environmental toxin may be more important than exposure in early life.

Aged↗
PubMed1991

Long-term outcome for patients and carers following hospital admission for stroke.

Outcome was assessed in 82 3(+)-year survivors from a cohort of 229 patients admitted to hospital with acute stroke; 71% were independent or only mildly disabled, 76% were living at home. Institutionalized patients were significantly older, less often married, and had more cognitive impairment than those at home. No patient who produced normal picture drawings (house, man, clock) was in institutional care, only two patients living alone had abnormal drawings. Of patients at home 39% had not seen their general practitioner (GP) in the last 6 months. GPs were less likely to see patients who were more severely disabled (p less than 0.05). Targeting of services seemed poor, there was no relationship between level of dependence and level of support from voluntary or statutory services. Forty-four of 49 chief informal carers were also interviewed; 30% showed marked strain. Carers had more problems with emotional reactions, sleep and social isolation than expected.

Acute Disease↗
PubMed1991

Electromyographic guidance of botulinum toxin treatment in cervical dystonia.

We report the results of electromyographic (EMG) guidance in the treatment of cervical dystonia with botulinum toxin. Eight-four patients received a total of 225 injection sessions. Overall there was moderate objective improvement in 78.7%. The mean dose of toxin was 269 +/- 39 mouse lethal units and the mean duration of maximum effect was 107 +/- 49 days. Complications included excessive neck weakness in 16.0% and dysphagia in 11.1% of the injection sessions. We conclude that EMG guidance is a safe and effective method of administering botulinum toxin in the treatment of cervical dystonia.

Adult↗
PubMed1991

Home assessments in geriatrics revisited: an audit of a routine home visiting service.

Routine home visiting is a luxury not afforded to other medical specialties. The practice of routine home assessment visiting in geriatric medicine was evaluated in a prospective study of 110 consecutive referrals to determine whether; the response to general practitioners referrals could be predicted from the information given at the time of referral and; to identify where home visiting identified additional information of value in directing services more appropriately. Requests for admission were accurately predicted in 86-96% of cases by the visiting and a control doctor respectively. Additional information of value in directing services and patient management was gained from the home visit in 30% of admissions, 58% of day hospital cases and 80% of outpatients. It is possible to predict the outcome of home visits although implementation of such predictions without direct communication with general practitioners would result in a small number of unnecessary admissions and referrals to day hospital services.

Aged↗
PubMed1991

Stroke and the carer.

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Cerebrovascular Disorders↗