Characteristic of acute ischemic infarction in the very elderly

Objective:To investigate the clinical features,neuroimaging data,and outcome of acute ischemic infarction events occurring in individuals aged 80 years or olden Methods:MRI、 DWI or CT,were performed among 58 elderly acute ischemic infarction patients admitted to our unit over a 2-year period.Patient age varied from 80 to 94 years(mean = 83.4 years),and 89% were males.Acodding to the focus of infarction,the patients separated into two groups.Patients in Group I had large infarcts on MR1 and extensive neurological deficits,while patients in Group 11 had small lacunar infarcts and minor neurological findings.The charts of all the patients were reviewed retrospectively and data on hypertension,diabetes mellitus,carotid stenosis,atrial fibrillation,hypercholesterolemia,coronary artery disease,treatments and outcome.Results:The results showed that the first clinic'al 'symptomatology in Group 1 were disorders of consciouseness(87.5% versus 23.8%;P=0.018),headache(43.8% versus 14.3%;P=0.026)and serious hemiplegia(93.8% versus 28.6%;P=0.012)to see frequently.In Group II hemiparesis(64.3% versus 6.3%;P=0.001)and vertigo(52.4% versus 25.0%;P=0.028)were more common.Patients in Group I showed a significantly lower proportion of diabetes(18.8% versus 54.8%;P=0.021)and hypertension(56.3% versus 88.1%;P=0.041)and a higher proportion of atrial fibrillation(43.8% versus 14.3%;P=0.030).Prevalence of carotid stenosis,hypercholesterolemia,coronary artery disease seems similar to that in Group II.Anticoagulants therapy(75.0% versus40.5%;P=0.035)was usually used in Group I.Antiplatelet agents were regularity used in both groups.The 30-day case fatality rate was approximately quintuple as high as in Group II patients(25.0% versus4.8%;P=0.001),and disability(activity of daily living,ADL score)in survivors was markedly higher(37.2±5.6 versus 19.2±3.6;p=0.021).Conclusions:The results indicate that major infarction are less prevalent in the geriatric population than small lacunar infarction and tend to be more related to hypertension and diabetes.The poorer infarction outcome found in major infarction during the first month MRI and DW1 patterns in acute stage should be helpful to verify etiology ofischemic infarction.Early synthetic management should be adopted during the very elderly with acute ischemic infarction.