A comparison of the Barthel Index and the OPCS disability instrument used to measure outcome after acute stroke.

The Barthel Index has been widely adopted as a measure of disability. The Office of Population Censuses and Surveys (OPCS) disability instrument was developed to provide a comprehensive measure of disability for use in the 1985 survey of disability among adults. Both measures were used on 150 patients surviving 1 year from a consecutive cohort of 246 admissions to hospital with acute stroke.

Improving the recording of the clinical assessment of stroke patients using a clerking pro forma.

In this study we examine whether the introduction of a clerking pro forma improves the completeness of the recording of the management of stroke patients and we review methodological issues important in this type of audit. We prospectively identified 244 consecutive stroke patients before and after the introduction of the pro forma. Patient case notes were traced and audited using a specifically designed form.

Prognostic value and reproducibility of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group.

Background And Purpose: The use of three methods of measuring carotid stenosis, which produce different values on the same angiograms, has caused confusion and reduced the generalizability of the results of research. If the results of future studies are to be properly applied to clinical practice, and if noninvasive methods of imaging are to be properly validated against angiography, a single, standard method of measurement of stenosis on angiograms must be adopted. This standard method should be selected on the bases of its ability to predict risk of ipsilateral carotid distribution ischemic stroke and its reproducibility.

Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group.

Background And Purpose: There is confusion about how carotid stenosis should be measured on angiograms. If the results of research based on different methods of measurement of stenosis are to be discussed and the results of clinical trials properly applied to routine clinical practice, measurements made by the different methods must be formally compared.

Methods: The method of measurement of stenosis used in the European Carotid Surgery Trial (ECST), that used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and a method based on measurement of the common carotid (CC) artery lumen diameter were compared.

Simvastatin-induced rhabdomyolysis.

At a time of increasing use of simvastatin and other "statin" drugs for cholesterol lowering, we report a case of simvastatin-induced acute massive rhabdomyolysis with renal failure in a woman with primary biliary cirrhosis, occurring 2 years after starting the drug. The differential diagnosis is highlighted and the literature reviewed.

Perceptions and knowledge of stroke among surviving patients with stroke and their carers.

As part of a survey to collect data which would be useful in planning a district stroke service we set out to discover what the service users' (patients' and carers') perceptions and knowledge of their illness were. We prospectively identified 164 consecutive patients with acute stroke admitted to hospital. Of the 110 (67%) survivors 65 (59%) patients and 80 (73%) carers completed a semi-structured interview.

Clinical heterogeneity of familial motor neuron disease: report of 11 pedigrees from a population based study in Scotland. The Scottish Motor Neuron Disease Research Group.

Five percent of incident patients with MND in Scotland 1989-1990 had a family history of this disease. This paper assesses the demographic and clinical features of this group.

Long-term prognosis of transient lone bilateral blindness in adolescents and young adults.

We describe a group of 14 patients aged 8-38 years at presentation who had one or more sudden transient attacks of bilateral blindness. Eight patients described bilateral blindness as their only symptom whereas six others experienced some mild associated symptoms. Visual loss always developed within seconds and attacks were often precipitated by exercise, stress, or postural change.

Depressive disorders in long-term survivors of stroke. Associations with demographic and social factors, functional status, and brain lesion volume.

Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM-III-R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was associated with impaired physical and cognitive functioning, greater age, residence in an institution, absence of a close personal relationship, and larger original brain lesion. Of these variables, only functional dependence (odds ratio 16.

Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project.

Background And Purpose: There have been few community-based studies of long-term prognosis after acute stroke. This study aims to provide precise estimates of the absolute and relative risks of stroke recurrence in an unselected cohort of patients with a first-ever stroke.

Methods: Six hundred seventy-five patients were registered in a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed for up to 6.

Prevalence of impaired cerebrovascular reserve in patients with symptomatic carotid artery disease.

Cerebrovascular reserve (CVR) was studied in 104 consecutive patients with symptomatic carotid territory disease and ipsilateral internal carotid artery stenosis. Overall, 30 of 104 patients (29 per cent) had impaired CVR. The frequency of CVR impairment increased with the severity of internal carotid artery stenosis: impairment was present in none of 11 patients with stenosis of less than 50 per cent, four of 24 with stenosis of 50-69 per cent, 14 of 41 with stenosis of 70-89 per cent and 12 of 28 with stenosis of 90-99 per cent.

Interobserver reliability of a clinical classification of acute cerebral infarction.

Background And Purpose: The Oxfordshire Community Stroke Project (OCSP) clinical classification of subtypes of cerebral infarction (total and partial anterior circulation infarction, lacunar infarction, and posterior circulation infarction) can be used to predict early mortality, functional outcome, and whether the infarct was likely due to large- or small-vessel occlusion. The OCSP classification was originally developed and tested by neurologists as part of a community-based study of first-ever stroke, in which some cases were seen after the acute phase. We examined the interobserver reliability of the classification when used in everyday clinical practice in patients seen during the acute phase of stroke shortly after admission to the hospital.

Motor neuron disease: a disease of old age.

There is little information dealing specifically with motor neuron disease (MND) in the elderly. Given current epidemiological trends, geriatricians will be increasingly called upon to diagnose and manage this condition. We report four patients who presented within a six month period to a geriatric medical unit, and place this experience in the perspective of 229 patients from a population-based study of adult-onset MND in Scotland in 1989 and 1990.

Risk factors for motor neuron disease: a case-control study based on patients from the Scottish Motor Neuron Disease Register.

In order to identify risk factors for the subsequent development of motor neuron disease (MND) we have carried out a case-control study of incident patients in Scotland, identified using the Scottish Motor Neuron Disease Register. A standard questionnaire was given to 103 patients and the same number of community controls matched on a one to one basis using the general practitioner's (GP) age and sex register. Recall bias was minimised by using GP records to verify the subject's report.