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Biomedical subjects

T S Olsen

Publications and source records attributed to T S Olsen.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Leucoaraiosis in patients with acute apoplexy. The Copenhagen Stroke Study].

Leuco-araiosis (LA) is a common finding in patients with stroke. The cause(s) of LA, risk factors and the clinical significance remains largely unknown. This prospective, community-based study of 1351 patients with acute stroke/TIA was undertaken to uncover factors of importance in the development of LA, and to assess the impact of LA on the prognosis of stroke. The diagnosis of LA was based on CT scan. Fifteen percent of the patients had LA. Age was the only factor that significantly increased the risk of LA (OR 2.4 per 10-year increase; 95% CI 1.8 to 3.1), whereas atrial fibrillation decreased the risk of LA (OR 0.26; 95% CI 0.13 to 0.52). Moderate daily alcohol consumption (one to five drinks) was associated with a reduced risk (OR 0.50; 95% CI 0.28 to 0.87), but more heavy alcohol consumption (more than five drinks) tended to increase the risk of LA (OR 1.3; 95% CI 0.5 to 3.3). LA did not influence the prognosis of stroke with regard to neurological outcome (p = 0.20), functional outcome (p = 0.47), length of hospital stay (p = 0.75), and mortality (p = 0.31). The relation between daily alcohol intake and LA seems to be U-shaped, like the relation between alcohol and coronary heart disease, alcohol and mortality, and alcohol and stroke. The presence of LA did not influence the outcome of stroke.

Acute Disease↗
PubMed1996

Orientation in the acute and chronic stroke patient: impact on ADL and social activities. The Copenhagen Stroke Study.

OBJECTIVES: To determine the influence of initially lowered orientation on rehabilitation outcome in stroke patients, and how decreased orientation 6 months after stroke influences ADL and social activities. DESIGN: Prospective, consecutive, and community based. SETTING: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were completed within the unit. PATIENTS: 524 patients with acute stroke. MAIN OUTCOME MEASURES: Basic ADL assessed by the Barthel Index (BI) at discharge; discharge placement; higher level ADL and social functions assessed by the Frenchay Activity Index(FAI) at a 6-month follow-up. RESULTS: The independent influence of orientation in acute stroke on rehabilitation outcome was analyzed with multiple linear and logistic regression models, using initial stroke severity (Scandinavian Neurologic Stroke Scale), initial BI, age, sex, comorbidity, prior stroke, and marital status as covariates. A one-point decrease in orientation decreased BI with 9 points (coefficient b=8.66, SE(b)=1.02,p<.0001) and reduced the likelihood (1.49, 95% CI: 1.05 to 2.11) of discharge to independent living (b=.40, SE(b)=.18,p=.026). Follow-up examinations 6 month poststroke showed that decreased orientation at this point still exerted a marked, negative influence on ADL and social functions (BI: coefficient b=12.06, SE(b)=1.95,p<.0001; FAI: coefficient b=6.28, SE(b)=1.42,p<.0001). CONCLUSION: The level of orientation influences basic ADL and higher level ADL and social activities in acute as well as chronic stroke. This finding suggests that rehabilitation of memory and attention might be relevant in stroke patients with impaired orientation.

Activities of Daily Living↗
PubMed1996

Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen Stroke Study.

OBJECTIVES: A "pusher syndrome" encompassing postural imbalance and hemineglect is believed to aggravate the prognosis of stroke patients. Our aim was to determine the incidence, associated neuropsychological symptoms, and the consequences for rehabilitation of ipsilateral pushing. DESIGN: Consecutive and community-based. SETTING: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were complete within the unit. PATIENTS: 647 acute stroke patients admitted during a 1-year period. Excluded were 320 patients who did not receive physiotherapy because they did not have pareses of the leg, had a fast remission, or died. MAIN OUTCOME MEASURES: Gain in activities of daily living (ADL) function (Barthel Index), time course of functional remission, and discharge rate to nursing home. The independent impact of ipsilateral pushing was analyzed with multiple linear and logistic regression analyses. RESULTS: Ipsilateral pushing was found in 10% of the included patients. No significant differences were found in the incidence of hemineglect and anosognosia between patients with and without ipsilateral pushing. No association with side of stroke lesion was found. Ipsilateral pushing had no independent influence on gain in ADL function or discharge rate to nursing home, but patients with ipsilateral pushing used 3.6 weeks (p < .0001) more to reach the same final outcome level than did patients without ipsilateral pushing. CONCLUSIONS: The existence of a "pusher syndrome" was not confirmed. Ipsilateral pushing did not affect functional outcome, but slowed the process of recovery considerably.

Activities of Daily Living↗
PubMed1996

Decreased serum testosterone in men with acute ischemic stroke.

Serum levels of total and free testosterone and 17 beta-estradiol were determined in 144 men with acute ischemic stroke and 47 healthy male control subjects. Blood samples from patients were drawn a mean of 3 days after stroke onset and also 6 months after admission in a subgroup of 45 patients. Initial stroke severity was assessed on the Scandinavian Stroke Scale and infarct size by computed tomographic scan. Mean total serum testosterone was 13.8 +/- 0.5 nmol/L in stroke patients and 16.5 +/- 0.7 nmol/L in control subjects (P = .002); the respective values for free serum testosterone were 40.8 +/- 1.3 and 51.0 +/- 2.2 pmol/L (P = .0001). Both total and free testosterone were significantly inversely associated with stroke severity and 6-month mortality, and total testosterone was significantly inversely associated with infarct size. The differences in total and free testosterone levels between patients and control subjects could not be explained by 10 putative risk factors for stroke, including age, blood pressure, diabetes, ischemic heart disease, smoking, and atrial fibrillation. Total and free testosterone levels tended to normalize 6 months after the stroke. There was no difference between patients and control subjects in serum 17 beta-estradiol levels. These results support the idea that testosterone affects the pathogenesis of ischemic stroke in men.

Acute Disease↗
PubMed1996

Acute stroke with atrial fibrillation. The Copenhagen Stroke Study.

BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. Many physicians remain reluctant to provide stroke prevention by anticoagulant therapy especially for elderly individuals with AF. Using multivariate regression analyses, we studied the characteristics and the prognosis of stroke in patients with AF. METHODS: The study is part of the Copenhagen Stroke Study, a prospective, community-based study of 1197 patients with acute stroke treated on a stroke unit from the time of acute admission to the end of rehabilitation. Initial stroke severity was measured by the Scandinavian Neurological Stroke Scale (SSS). Neurological and functional outcomes were evaluated by the SSS and the Barthel Index. RESULTS: AF was diagnosed in 18% of the patients. AF increased steeply with age in the stroke population, from 2% in patients < 50 years old, 15% in patients in their 70s, and 28% in patients in their 80s, to 40% in patients > or = 90 years of age. In a multivariate analysis AF was associated with age (odds ratio [OR], 2.0 per 10-year increase; 95% confidence ratio [CI], 1.6 to 2.6), ischemic heart disease (OR, 3.4; 95% CI, 2.4 to 4.8), previous stroke (OR, 1.8; 95% CI, 1.2 to 2.6), and systolic blood pressure (OR, 0.93 per 10-mm Hg increases; 95% CI, 0.88 to 0.99), but not with sex, diabetes, hypertension, previous transient ischemic attack, or silent infarction on computed tomography. Patients with AF had a higher mortality rate (OR, 1.7; 95% CI, 1.2 to 2.5), longer hospital stays (50 days versus 40 days, P < .001), and a lower discharge rate to their own homes (OR, 0.60; 95% CI, 0.44 to 0.85). Neurological and functional outcomes were markedly poorer in patients with AF. Poorer outcome was exclusively explained by initially more-severe strokes. CONCLUSIONS: Stroke in patients with AF is generally more severe and outcome markedly poorer than in patients with sinus rhythm. This accentuates the importance of anticoagulant treatment of individuals with AF. A lower blood pressure in the acute stage of stroke may contribute to the increased stroke severity in patients with AF.

Aged↗
PubMed1996

Factors delaying hospital admission in acute stroke: the Copenhagen Stroke Study.

Medical treatment of stroke is dependent on a narrow therapeutic time window. We prospectively analyzed the influence of demographic, medical, and pathophysiologic factors on admission delay in 1,197 unselected, acute stroke patients. Twenty five percent were admitted within 3 1/2 hours, 35% within 6 hours, 50% within 14 hours, and 68% within 24 hours after stroke onset. Living alone (odds ratio [OR] 1.75, 95% CI 1.3 to 2.3) and retired working status (OR 1.61, 95% CI 1.01 to 2.54) delayed admission. A well-working social network thus seems important to early admission. The milder the stroke, the higher was the risk of delayed admission (OR 1.25 per 10 points decrease in stroke severity [Scandinavian Neurological Stroke Scale score on admission], 95% CI 1.14 to 1.36). A history of TIA increased the relative chance of early admission by odds 1.64 (95% CI 1.06 to 2.54). Other factors such as age, sex, diabetes, hypertension, ischemic heart disease, other comorbidity, previous stroke, headache, aphasia, apraxia, anosognosia, neglect, lowered consciousness, mental status (Mini-Mental State Examination) and type of stroke (hemorrhage/infarct) had no independent influence on admission time. Admission was markedly delayed in most patients. This represents a major barrier to medical treatment. Patients with the most severe strokes are admitted early, but patients with milder symptoms should also be encouraged to seek immediate admission. The observation that a history of TIA reduced admission time indicates that an increase in public awareness and knowledge may reduce delay and save precious time.

Acute Disease↗
PubMed1995

Reproducibility of the Banff classification of renal allograft pathology. Inter- and intraobserver variation.

The present study was undertaken to investigate the inter- and intraobserver variation in use of the scoring system for glomerulitis, vasculitis, interstitial inflammation, tubulitis and arteriolar hyalinosis that is an essential part of the recently proposed Banff classification of renal allograft biopsies. Seventy-seven biopsies done less than 90 days after transplantation were included. The scoring was done blindly by five pathologists on biopsies stained with H&E and PAS. The volume fraction of interstitial inflammation was estimated. Spearman rank correlation coefficient and kappa values were used for the evaluation of reproducibility. The results of both inter- and intraobserver variability showed a good correlation and reasonable kappa values for vasculitis, interstitial inflammatory infiltration, and tubulitis. Less-good correlation was found for glomerulitis and arteriolar hyalinosis. The interobserver kappa score for grading of the rejection severity was 0.40 overall but 0.56 when only presence or absence of acute rejection was considered and 0.66 for presence or absence of vasculitis. Weighted kappa values for interobserver vasculitis score and rejection grading were 0.58 and 0.55, respectively. A strong association existed between the volume fraction of interstitial inflammation and the semiquantitative scoring for interstitial inflammation. In conclusion, the good correlations for the key elements in the grading of the allograft biopsies in the present classification system, confirmed the utility of the defined criteria for grading rejection. More precisely defined criteria or simplification of the scoring system are needed for glomerulitis and arteriolar hyalinosis--parameters not used in the diagnosis of rejection.

Biopsy↗
PubMed1995

[Progressive apoplexy. Incidence, risk factors and prognosis--the Copenhagen Stroke Study].

Clinical progression after arrival to hospital is frequent in acute stroke patients. Risk factors and mechanisms behind progression have remained largely unknown. This prospective, community-based study of 1006 acute stroke patients was undertaken to uncover factors of importance in the development of stroke-in-progression (SIP), and to assess the impact of SIP on prognosis. The diagnosis of progression was based on the Scandinavian Neurological Stroke Scale (SSS). Patients were divided according to whether progression occurred early (within 36 hours from stroke onset) or late (within the first week from onset). A marked progression developed in 32%. The following risk factors for early progression were identified: Systolic blood pressure on admission decreased the relative risk by 0.66 per 20 mmHg elevation (95% CI 0.55-0.83) and diabetes increased the relative risk by 1.9 (95% CI 1.1-3.3). Stroke severity was the only risk factor found in late progression (OR 1.4 per 20-point increase in stroke severity (95% CI 1.1-1.7)). These relations were independent of age, sex, blood glucose, heart disease and other stroke risk factors. SIP doubled mortality (0.001) and numbers discharged to nursing homes (0.001), and was associated with increased neurological deficits and decreased functional ability (0.0001) in survivors. These findings suggest that a causal relationship exists between the systemic blood pressure and the development of progression in the early phase of stroke and that this relationship is enhanced in patients with diabetes. The impact of SIP on prognosis is severe and lasting.

Aged↗
PubMed1995

[Treatment of high blood pressure in patients with acute apoplexy].

The study was performed to investigate how often reduction of high blood pressure (> or = 220 mmHg systolic and or > or = 120 mmHg diastolic) was attempted in patients with acute stroke or transient ischemic attacks (TIA). Of 1351 consecutive patients with acute stroke or TIA 119 had high blood pressure on admission. In 15 patients the stroke was so severe that treatment was not considered. In the remaining 104 patients reduction of the blood pressure was attempted in 28 (27%); in 23 patients immediately following admission. None of the patients had symptoms or signs of hypertensive encephalopathy. It is concluded that reduction of high blood pressure in patients with stroke or TIA is attempted too often. As autoregulation is commonly impaired in acute stroke, reduction of systemic blood pressure may enhance ischaemic tissue damage. Reduction of blood pressure in acute stroke should be considered only in case of hypertensive encephalopathy.

Acute Disease↗
PubMed1995

[Reducing hypertension may worsen symptoms of acute apoplexy].

Patients with acute stroke often present with high blood pressure (BP) on hospital admission. Because hypertension is a risk factor for stroke, and because severe BP elevation may increase oedema and the risk of haemorrhage, acute antihypertensive therapy might seem reasonable. On the other hand, the increase in BP in the acute stage might be considered a beneficial pathophysiological response maintaining the perfusion pressure to the ischaemic area and, in particular, the surrounding penumbra. As illustrated in the case presented here, lowering the BP in the early stage may be associated with progression of neurological deficits, very likely due to a reduction of perfusion to the penumbra thus enlarging the infarct.

Acute Disease↗
PubMed1995

Intracerebral hemorrhage versus infarction: stroke severity, risk factors, and prognosis.

The purpose of this study was to compare stroke severity, risk factors, and prognosis in patients with intracerebral hemorrhage versus infarction. We prospectively studied 1,000 unselected patients with acute stroke of a verified type in the Copenhagen Stoke Study. Neurological deficits and functional disabilities were evaluated weekly from the time of acute admission throughout the rehabilitation period. Eighty-eight (9%) had intracerebral hemorrhage. The relative frequency of intracerebral hemorrhage rose exponentially with increasing stroke severity. In multivariate analyses, stroke type had no influence on mortality, neurological outcome, functional outcome, or the time course of recovery. Initial stroke severity was the all-important prognostic factor. The relative importance of hypertension and blood pressure on admission was not greater for intracerebral hemorrhage than for infarction. No preponderance was found between type of stroke and sex, age, and smoking. Diabetes, ischemic heart disease, and elevated serum total cholesterol level all favored cerebral infarction as opposed to intracerebral hemorrhage. We conclude that the type of stroke per se has no influence on stroke prognosis in general; the extent of the injury is decisive. The poorer prognosis in patients with intracerebral hemorrhage is due to the increase in frequency of intracerebral hemorrhage with increasing stroke severity. The likelihood of cerebral infarction occurring as opposed to intracerebral hemorrhage seems increased fivefold in stroke patients with diabetes. Hypertension and blood pressure on admission were not predictors of stroke type.

Aged↗
PubMed1995

Aphasia in acute stroke: incidence, determinants, and recovery.

Knowledge of the frequency and remission of aphasia is essential for the rehabilitation of stroke patients and provides insight into the brain organization of language. We studied prospectively and consecutively an unselected and community-based sample of 881 patients with acute stroke. Assessment of aphasia was done at admission, weekly during the hospital stay, and at a 6-month follow-up using the aphasia score of the Scandinavian Stroke Scale. Thirty-eight percent had aphasia at the time of admission; at discharge 18% had aphasia. Sex was not a determinant of aphasia in stroke, and no sex difference in the anterior-posterior distribution of lesions was found. The remission curve was steep: Stationary language function in 95% was reached within 2 weeks in those with initial mild aphasia, within 6 weeks in those with moderate, and within 10 weeks in those with severe aphasia. A valid prognosis of aphasia could be made within 1 to 4 weeks after the stroke depending on the initial severity of aphasia. Initial severity of aphasia was the only clinically relevant predictor of aphasia outcome. Sex, handedness, and side of stroke lesion were not independent outcome predictors, and the influence of age was minimal.

Acute Disease↗
PubMed1995

Recovery of walking function in stroke patients: the Copenhagen Stroke Study.

Time course and degree of the recovery of walking function after stroke and the influence of initial lower extremity (LE) paresis were studied prospectively in a community-based population of 804 consecutive acute stroke patients. Walking function and degree of LE paresis were assessed weekly using the Barthel index and the Scandinavian Neurological Stroke scale, respectively. Initially, 51% had no walking function, 12% could walk with assistance, and 37% had independent walking function. At the end of rehabilitation, 21% had died, 18% had no walking function, 11% could walk with assistance, and 50% had independent walking function. Recovery of walking function occurs in 95% of the patients within the first 11 weeks after stroke. The time and the degree of recovery are related to both the degree of initial impairment of walking function and to the severity of LE paresis, p < .0001. A valid prognosis of walking function in patients with initially no/mild/moderate leg paresis can be made in 3 weeks, and further recovery should not be expected after 9 weeks. A valid prognosis of walking function in patients with initially severe leg paresis or paralysis can be made in 6 weeks, and further improvement of walking function should not be expected later than 11 weeks after stroke.

Aged↗
PubMed1995

Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen Stroke Study.

OBJECTIVE: To evaluate the outcome of stroke stratified according to both initial stroke severity and initial level of disability. DESIGN: Prospective, consecutive, and community based. SETTING: A stroke unit of a hospital in Denmark. This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the City of Copenhagen. Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age, stroke severity, and premorbid condition. PATIENTS: 1197 patients with acute stroke. MAIN OUTCOME MEASURES: Primary outcome was measured as death, discharge to nursing home, or to own home. Secondary outcome was measured as neurological deficits and functional disabilities after completed rehabilitation and again 6 months after stroke onset, using the Scandinavian Neurological Stroke Scale and the Barthel Index. RESULTS: Stroke was initially very severe in 223 (19%) of the patients, severe in 171 (14%), moderate in 316 (26%), and mild in 487 (41%) patients. Two hundred and fifty (21%) patients died during hospital stay, 177 (15%) were discharged to nursing home, and 770 (64%) patients were discharged to their own home. After completed rehabilitation, 11% of survivors still had severe or very severe neurological deficits, 11% had moderate deficits, and 78% had no or only mild deficits; 20% were severely or very severely disabled, 8% were moderately disabled, 26% were mildly disabled, and 46% had no disability in activities of daily living. Detailed information on outcome stratified according to initial stroke severity/disability also is presented. CONCLUSIONS: This study provides a thorough description of the needs for stroke rehabilitation in the community and the amount of postrehabilitation disability in stroke survivors. For outcome prediction, the results can be used as a reliable tool for prognostication of the chances (or risks) of various outcomes in patients characterized by initial degree of stroke severity and/or functional disability using simple, reliable scores in the acute phase of stroke. However, the results should not be used as a guideline for selecting patients for rehabilitation in the acute phase because even the most severe cases regularly experience meaningful improvement during rehabilitation.

Activities of Daily Living↗
PubMed1995

Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study.

OBJECTIVE: To determine the time course of both neurological and functional recovery from stroke. DESIGN: Prospective, consecutive, and community based. SETTING: The stroke unit of a hospital in Copenhagen, Denmark. This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the city of Copenhagen. Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age, stroke severity, and premorbid condition. PATIENTS: 1,197 patients with acute stroke. MAIN OUTCOME MEASURES: Weekly examinations of neurological deficits (using the Scandinavian Neurological Stroke Scale) and functional disabilities (Activity of Daily Living (ADL) measured by the Barthel Index) were performed from the time of acute admission to the end of rehabilitation. These evaluations were repeated 6 months poststroke. Time course of recovery was stratified according to initial stroke severity and disability. RESULTS: Functional recovery was completed within 12.5 weeks (95% confidence interval (CI) 11.6 to 13.4) from stroke onset in 95% of the patients. However, 80% of the patients had reached their best ADL function within 6 weeks (CI 5.3 to 6.7) from onset. The time course of functional recovery was strongly related to initial stroke severity. Best ADL function was reached within 8.5 weeks (CI 8 to 9) in patients with initially mild strokes, within 13 weeks (CI 12 to 14) in patients with moderate strokes, within 17 weeks (CI 15 to 19) in patients with severe strokes, and within 20 weeks (CI 16 to 24) in patients with very severe strokes. After these time-points, no significant changes occurred. However, a valid prognosis of functional outcome can be made much earlier. Best ADL function was reached by 80% of the patients with initially mild strokes within 3 weeks (CI 2.6 to 3.4), within 7 weeks (CI 6 to 8) of the patients with moderate strokes, and within 11.5 weeks (CI 10 to 13) of the patients with severe and very severe strokes. The time course of neurological recovery followed a pattern similar to that of functional recovery, but preceeded functional recovery by 2 weeks on average. CONCLUSIONS: A reliable prognosis can in all stroke patients be made within 12 weeks from stroke onset. Even in patients with severe and very severe strokes, neurological and functional recovery should not be expected after the first 5 months.

Activities of Daily Living↗