[Epidemiology and prognostic significance of bladder sphincter disorders after an initial cerebral hemisphere vascular accident]. / Epidémiologie et signification pronostique des troubles vésicosphinctériens après un premier accident vasculaire cérébral hémisphérique.

OBJECTIVE: To document incidence of poststroke urinary incontinence and retention and to determine its effect on 3 months outcome. METHODS: Prospective cohort study. One hundred fifty-five cases of first hemispherical stroke were classified by continence status, retention or incontinence, at D2 after stroke. Age, sex, stroke location and aetiology, hypertension, diabetes were noted. Outcome data collected at D15 and D90 included impairments, disabilities, quality of life and case fatality rates. Disabilities were measured with Barthel Index (BI), Franchay Arm Test (FAT), New Functional Ambulation Classification (NFAC) and quality of life with EuroQol. RESULTS: Of the 155 patients, 62 had initial urinary disorders. The incidence was 40% at D2, 32% at D15 and 19% at D90. Retention represented 36% of urinary disorders at D2 and D15 and only 19% at D90. Urinary disorders were associated with motor weakness, lower Barthel Index, dysphasia, aphasia, apraxia and unilateral neglect. There was no relation with sex, age, stroke aetiology and diabetes. At D90, patients with initial urinary disorders had higher case fatality rates 22% versus 16% (P < 0.0001) and greater disabilities: BI of 60 versus 90 (P < 0.0001), NFAC of five versus seven (P < 0.0001), FAT of four versus six (P = 0.0019). CONCLUSION: Poststroke urinary disorders were associated with stroke gravity and adversely affected D90 stroke survival rates and functional outcome. Retention was strongly associated with D90 survival rates.

[Epidemiology of pes varus and/or equinus one year after a first cerebral hemisphere stroke: apropos of a cohort of 86 patients]. / Epidémiologie des pieds varus et/ou équin un an après un premier accident vasculaire cérébral hémisphérique: à propos d'une cohorte de 86 patients.

OBJECTIVE: To determine the frequency and the functional consequences of varus equinus in stabilized vascular hemiplegia. METHODS: Prospective cohort study of 86 hemiplegic patients. All patients consecutively admitted for a first hemispheral stroke between July 2001 and January 2002 were included. The evaluation consisted in a clinical examination and a descriptive study of gait. The functional capacity of patients with and without varus equinus were compared using the Barthel index, the New Functional Ambulation Classification (NFAC), the confortable ten meters gait speed and gait perimeter. RESULTS: The incidence of varus equinus was 18%. There was no difference in gait speed (0.8 m/s), NFAC or Barthel index between patients with or without varus equinus. Patients with varus equinus had had more specialized, intensive and prolonged rehabilitation. The only prognostic factor that could be identified was the motor impairment and the existence of spasticity. DISCUSSION: The mechanism of varus equinus is thought to be mainly the over-activity of gastrocnemius and solaris compared to that of the tibialis anterior, associated to the weakness of fibular muscles. The role of tibialis posterior is thought to be less important. The frequency of varus equinus after a first hemispheral stroke was low and the consequences were limited. This could be in part explained by the access of these patients to early, specialized and prolonged rehabilitation care.

[Reliability of TcPO(2) measurement in the upper limb]. / Evaluation de la reproductibilité de la mesure transcutanée de la pression partielle d'oxygène (TcPO(2)) au niveau de la main.

INTRODUCTION: Several reports suggest the usefulness of transcutaneous oxygen tension (TcPO(2)) in assessing the shoulder hand syndrome in stroke patients. But the literature presents a number of conflicting views on the variation of TcPO(2) values in this case. We found no report demonstrating the reliability of TcPO(2) measurements in the upper limb. The aim of this study was to evaluate the reliability of TcPO(2) measurements and investigate whether TcPO(2) can be used to evaluate the shoulder hand syndrome after stroke. MATERIAL AND METHODS: The TcPO(2) values were obtained on two separate occasions at one-day interval on 18 normal volunteers. Basal TcPO(2), local vasomotor reflex and reaction to ischemia were assessed. RESULTS: Thirty-six upper limbs were tested. The reliability was bad. We found that measurements of TcPO(2) varied by an average of 7.89 +/- 7.6 mmHg for a coefficient of variation of 96%. CONCLUSION: The reliability of TcPO(2) measurement was not sufficient to recommend this method in this indication.