Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit

BACKGROUND AND PURPOSE

We sought to study overall and domain-specific quality of life in stroke survivors 1 year after stroke and to identify variables that could predict quality of life after stroke.

METHODS

We followed up for 1 year a cohort of 118 patients consecutively admitted to our stroke unit at San Carlos University Hospital in Madrid, Spain. The final series at 1-year follow-up consisted of 90 survivors (41 women and 49 men; mean age, 68 years; range, 32 to 90 years). A cross-sectional, descriptive design was developed. Patients completed a questionnaire that included socioeconomic variables, Hamilton Rating Scale for Depression, Sickness Impact Profile (SIP), Short Form 36, Frenchay Index, Barthel Index, Rankin Scale, and Scandinavian Stroke Scale. Independent variables were sex, age, functional status, motor impairment, and depression. We developed an ANOVA model for statistical analysis.

RESULTS

We interviewed 79 patients with ischemic and 11 with hemorrhagic stroke. Thirty-eight percent of patients scored in the depressed range. Variables related to depression were status as a housewife, female sex, inability to work because of disability, and diminished social activity (P:<0.0001). Mean total SIP (24.3), SIP psychosocial dimension (27.5), and SIP physical dimension (21.2) were correlated with disability, female sex, motor impairment, and depression (P:<0.0001).

CONCLUSIONS

Functional status and depression were identified as predictors of quality of life. Patients independent in their activities of daily living suffered from a deterioration of the psychosocial dimension of the SIP.

[Intraparenchymal hematomas: specific features in children]

INTRODUCTION

Intraparenchymatous haemorrhages are rare in infancy, but their effects may be very harmful. The aetiology, clinical characteristics and prognosis regarding life and function are different from those in adults.

OBJECTIVE

We decided to analyze the characteristics of this pathology in children and compare them with those in adults.

MATERIAL AND METHODS

We reviewed the clinical histories of the patients under 13 years of age presenting with a spontaneous intraparenchymatous haemorrhage during a 10 year period.

RESULTS

The study group was made up of 10 patients, 5 boys and 5 girls, aged between 23 days and 11 years. In 7 patients the aetiology was a burst arteriovenous malformation; in one a serious liver disorder due to alpha-l-antitrypsin deficiency; bleeding from an undiagnosed tumour caused another case and no aetiology was found in a further case. Two patients died, 6 patients had residual neurological defects and in the other two there were no sequelae.

CONCLUSIONS

Intraparenchymatous haematomas in children have a high mortality (20%) and many sequelae. The figures are comparable with those for elderly persons aged over 70 and much greater than in the case of young adults. The commonest aetiology is an arteriovenous malformation, followed at a considerable distance by coagulopathies and tumours.

[Basilar artery rostral occlusion syndrome. Clinico-radiological assessment of 56 patients]

We studied 56 patients, 30 women and 26 men ranging from 30 to 79 years of age (average age 64.5 +/- 10.4), who were admitted to our hospital between 1982 and August 1995 with clinical features compatible with occlusion at the level of the bifurcation of the basilar artery. The patients were selected following clinical and neuro-radiological criteria. All patients included in the study had two or more recent infarcts in the vertebro-basilar territory, related to involvement of the rostral region of the basilar artery. The diagnosis was confirmed by CT or MR scanning. The infarcts were in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. A thalamic infarct associated with an infarct in another region was the most frequent lesion. The CT-MR findings in the 56 cases were: 29 patients presented with a unilateral thalamic infarct associated with another infarct (23 occipital, 8 parietal, 6 brain-stem and 2 cerebellum). There were eight patients with bilateral thalamic infarcts and seven with bilateral occipital infarcts. In six patients the occipital infarct was associated with another infarct at a different level (parietal or cerebellar) and six patients had cerebellar infarcts together with an infarct of the mid-brain. In 22 of the patients, lesions were found in three or more areas. The commonest clinical findings were: Motor deficit (69.6%), abnormal eye movements (44.5%), cerebellar dysfunction (42.8%), altered level of consciousness (32.1%), visual field defects (28.5%), pupil anomalies (19.6%). The most frequently associated risk factors were: Arterial hypertension (58.9%), a history of ACV (32.1%) and atrial fibrillation (21.4%). Mortality was 5.7%. In contrast to the classical descriptions, motor defecit was the commonest symptom in our series.