Clinical Advances in the Diagnosis of Cerebral Vascular Disease

I have chosen some thoughts about recent clinical advances in the diagnosis of cerebral vascular disease, which I feel are appropriate for this paper, confining my discussion to the signs, symptoms, natural history, and risk factors of cerebral vascular disease

Cerebral Blood Flow Studies in Stroke

This consideration of the relationship of neuro-transmitters not only to cerebral infarction but also to subarachnoid hemorrhage is, to my mind, the most promising area of investigation over the next decade. There is also a quantity of evidence that neurotransmitters play a large part in spasm following subarachnoid hemorrhage and in the disturbance of neurological function in that situation. Following subarachnoid hemorrhage, some remediable medical problems arise. Apart from clipping of the aneurysm, which the neurosurgeons are able to do, there is the problem of communicating hydrocephalus, which is extremely common in about 40% of patients. It can be discerned by the method of determining regional CBF and doing a spinal tap. If you note an increase in cerebral blood flow with removal of 25 cc of spinal fluid, you know you have a problem with communicating hydrocephalus. This is because autoregulation is disturbed. This increase will not occur when a spinal tap is done on a normal person who does not have communicating hydrocephalus. Finally, one can give glycerol and reduce the brain edema in patients with subarachnoid hemorrhage and brain swelling

A Pilot Study Of Antihypertensive Therapy In Cerebrovascular Disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111248/1/j.1532-5415.1967.tb02802.x.pd

Black Hole Spectral States and Physical Connections

The dramatic changes seen in the X-ray spectral and timing properties of accreting black hole candidates (BHCs) provide important clues about the accretion and jet formation processes that occur in these systems. Dividing the different source behaviors into spectral states provides a framework for studying BHCs. To date, there have been three main classification schemes with Luminosity-based, Component-based, or Transition-based criteria. The canonical, Luminosity-based criteria and physical models that are based on this concept do not provide clear explanations for several phenomena, including hysteresis of spectral states and the presence of jets. I discuss the re-definitions of states, focusing on an application of the Component-based states to more than 400 RXTE observations of the recurrent BHC 4U 1630-47. We compare the X-ray properties for the recent 2002-2004 outburst to those of an earlier (1998) outburst, during which radio jets were observed. The results suggest a connection between hysteresis of states and major jet ejections, and it is possible that both of these are related to the evolution of the inner radius of the optically thick accretion disk.Comment: To appear in the Proceedings of COSPAR Colloquium "Spectra & Timing of Compact X-Ray Binaries," January 17-20, 2005, Mumbai, Indi

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes