Posterior Circulation Infarction Research Articles

Bilateral blindness following Russell's viper bite - a rare clinical presentation: a case report.

IntroductionRussell’s viper (Daboia russelii) is one of the most common medically important snakes reported in Sri Lanka. Its envenomation leads to significant mortality and morbidity with local, hematological, neurological and renal complications. Here we report the case of a patient who presented with bilateral blindness secondary to a bilateral posterior circulation ischemic stroke instead of the usual neurological manifestations of Russell’s viper envenomation. There were no reported cases of cortical blindness following a Russell’s viper bite. Only a few reported cases of ischemic strokes following a Russell’s viper bite were found in the literature.Case presentationA 54-year-old Sri Lankan woman developed bilateral blindness due to a posterior circulation infarct following Russell’s viper envenomation.ConclusionIschemic stroke following a Russell’s viper bite is very rare and cortical blindness is not reported as the clinical presentation. Also, we emphasize the importance of considering the possibility of ischemic stroke in patients who develop unusual neurological manifestations following Russell’s viper envenomation.

Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage

BackgroundThe Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance.MethodsWe constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).ResultsIn a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST.ConclusionsIncorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.

Epileptic seizures in patients with a posterior circulation infarct

OBJECTIVE: The aim of this study was to investigate the frequency of seizures and the clinical features of patients with seizures related to a posterior circulation infarct (POCI). MATERIAL and METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2011 and January 2012. The patients’ database information was retrospectively analyzed. Fifty-five patients with a POCI were included in the study. We reviewed all patients with epileptic seizures related to a POCI. Age, gender, recurrent stroke, risk factors, etiology, radiographic localization, the seizure type and onset time, and the electroencephalographic findings of patients were evaluated. We excluded all patients who had precipitating conditions during seizures such as taking drugs, acid-base disturbances, electrolyte imbalance, and history of epilepsy. RESULTS: Seizures were observed in four patients (3 male, 1 female) with a POCI related epileptic seizures (7.2%). The etiology of strokes was cardiac-embolic in 3 patients and vertebral artery dissection in 1 patient. Seizures occurred in 2 patients as presenting finding, in 1 patient within 7 days, and 1 patient within 28 days. Primary generalized tonic-clonic seizures occurred in 3 patients and simple partial seizures with secondary generalization in 1 patient. Three patients had cerebellum infarction at the left hemisphere. One patient had lateral medullary infarction at the right side. The electroencephalographic findings of patients were normal. CONCLUSION: Studies involving patients with seizures related to a POCI are novel and few in number. Three patients with seizure had cerebellum infarction. The cerebellum in these patients may contribute via different mechanisms over seizure activity.

Risk assessment of ischemic stroke associated pneumonia.

Cerebral stroke is a disease with a high disability rate and a high fatality rate. This study was undertaken to assess the risk of stroke associated pneumonia (SAP) in patients with ischemic stroke using A2DS2 score. Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows: age ≥75 years=1, atrial fibrillation=1, dysphagia=2, male sex=1; stroke severity: NIHSS score 0-4=0, 5-15=3, ≥16=5. The patients were divided into three groups according to A2DS2 score: 620 in score 0 group, 383 in score 1-9 group, and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows: newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection: (1) fever ≥38 °C; (2) newly occurred cough, productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain; (3) signs of pulmonary consolidation and/or wet rales; (4) peripheral white blood cell count ≥10×10(9)/L or ≤4×10(9)/L with or without nuclear shift to left, while excluding some diseases with clinical manifestations similar to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease, pulmonary edema, pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data. The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1-9 and score 0 groups (71.7% vs. 22.7%, 71.7% vs. 3.7%, respectively), whereas the mortality in the score≥10 group was significantly higher than that in the score 1-9 and score 0 groups (16.7% vs. 4.96%, 16.7% vs. 0.3%, respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were significantly higher than those in the SAP group and in the non-SAP group (35.1% vs.10.1%, 11.4% vs. 7.5%, respectively). The incidence of non-fermentative bacteria infection was significantly increased in the score≥10 group. A2DS2 score provides a basis for risk stratification of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.

Effect of Heart Failure on Acute Ischemic Stroke Severity

Objectives: To assess the impact of heart failure diseases on stroke severity and short term (1 month mortality). Materials and Methods: Totally, 200 patients admitted to Ain Shams university specialized hospital, were diagnosed clinically to have acute ischemic stroke within 3 days. History taking about previous heart disease was taken, and full general and neurological examinations were done. Full metabolic profile, cardiac examination and investigations were done. Carotid duplex, MRI stroke protocol and lastly clinical reevaluation using NIH Stroke Scale (NIHSS) after 1 month from stroke onset were done. Results: Patients with systolic dysfunction (EF ≤ 40%) had lacunar infarction in 18.75% of cases, partial anterior circulation infarction in 62.5% of cases, posterior circulation infarction in 6.25% of cases and total anterior circulation infarction in 12.5% of cases. Leucoaraiosis was present in 87% of cases and significant intracranial vessel stenosis was showed in 87.5% who had done MRI. Their median NIHSS score at admission was 10.5 with IQR of 5 - 21 and at follow-up it was 5 with IQR of 2.5 - 10.5. At follow-up 22.7% (5 patients) were dead. Conclusion: Systolic dysfunction (EF

A case of bilateral occipital lobe infarcts following Indian tree viper bite.

A case of bilateral occipital lobe infarcts following Indian tree viper bite.

THINK OUTSIDE THE BOX, COLLAPSE THE BOX, AND TAKE A SHARP KNIFE TO IT!

A 74 year–old woman presented in December 2011 with left sided cerebellar symptoms. She was initially diagnosed as having a posterior circulation infarction and discharged from hospital on appropriate medication....

Giant Cell Arteritis Causing Symmetric Bilateral Posterior Circulation Infarcts

An 82-year-old woman presented with bilateral, symmetric posterior circulation infarctions secondary to giant cell arteritis (GCA). Her atypical clinical presentation included a lack of headache and fever, but she exhibited signs of systemic illness including generalized weakness, cachexia, apathy, and anemia. Laboratory testing revealed a markedly elevated erythrocyte sedimentation rate, but only a borderline elevated C-reactive protein. Head and neck vascular imaging demonstrated a pattern of vertebral arterial narrowing consistent with GCA-a diagnosis confirmed by temporal artery biopsy. Her unusual symptomatic, laboratory, and imaging presentation highlights the importance of considering GCA in the differential diagnosis of unusual bilateral stroke syndromes, where early treatment decreases morbid outcomes.

Predictors of short-term outcome in posterior circulation strokes

Prediction of acute ischemic stroke outcome is essential for treatment planning, guidance of patient and relatives, and in the search for new therapeutic strategies. Previous examinations have focused mostly on anterior circulation infarcts with few studies examining diffusion-weighted MRI (DWI) data and functional outcome in posterior circulation (PC) infarcts.

Abstract TMP13: Baseline DWMRI Characteristics In Patients With Cryptogenic Stroke And Patent Foramen Ovale: Results From The Closure I Trial

Background: Cryptogenic stroke may have several etiologies including paradoxical embolism through a patent foramen ovale (PFO). A cardiac source of embolism may be suggested by multiple infarcts, sometimes hemorrhagic, in different vascular distributions or a cortical wedge shaped infarct. We report the baseline diffusion weighted MRI (DWMRI) characteristics in patients with cryptogenic stroke and a patent foramen ovale (PFO) from the CLOSURE I trial. Methods: CLOSURE I compared device closure versus medical therapy for secondary prevention in patients with cryptogenic TIA or stroke and a PFO. Of 909 patients randomized, 562 patients demonstrated acute infarcts on baseline DWMRI and are included in this analysis. Multivariate proportional hazard Cox regression compared imaging subgroups with remaining randomized patients Results: Single infarcts were found in 62% of patients. Of these, 61% were anterior circulation, 30% posterior, and 8.5% were of uncertain territory. Of the anterior circulation infarcts, 40% were cortical, 36% subcortical, and 24% affected both the cortical and subcortical regions. Of the posterior circulation infarcts, 45% were thalamic or cerebellar. Of 562 patients, 18.5% had a single subcortical lesion <1.5cm in diameter and met the radiological definition of an acute lacunar infarct. Multiple infarcts were found in 38%. Infarcts in a single vascular territory were found in 23%, often in the anterior circulation (66%). Infarcts in multiple vascular territories were found in 15%. Hemorrhagic infarction was present in 9%. Adjusting for patient characteristics, no significant difference in 2 year rate of TIA, stroke or death was found compared to remaining randomized patients. Discussion: The specificity of infarct patterns for embolism in patients with cryptogenic stroke and a PFO is uncertain. We found no significant relationship between lacunar or subcortical infarction and the risk of recurrent TIA or stroke. Baseline infarct patterns on DWMRI in patients with cryptogenic stroke and PFO may not be useful in predicting recurrent stroke risk or determining best prevention therapy.

Coiling Occlusion of the Vertebral Artery for a Patient with Recurrent Posterior Circulation TIAs

Recurrent posterior circulation infarcts frequently involve multiple vascular territories, suggesting an embolic source. We describe a patient with left vertebral artery occlusion who had recurrent transient ischaemic attacks due to cerebral embolization originating from the occluded vertebral artery in spite of optimal anticoagulant and antithrombotic treatment. This was successfully managed by coiling occlusion of the vertebral artery with no recurrence of symptoms over one year of follow-up. To our knowledge, this is the first report of coiling occlusion in the treatment of recurrent vertebral artery embolization.

The evaluation of serum uric acid levels in the ischemic stroke subtypes

OBJECTIVE: Uric acid is a water-soluble antioxidant which is the end-product of purine metabolism. Several studies indicated that high levels of serum uric acid increased the risk of cerebrovascular events and some of them reported poor prognosis with increased serum uric acid levels in stroke patients. Our aim was to analyse serum uric acid levels in the early phase of ischemic stroke and determine whether increased levels of uric acid are associated with ischemic stroke subtypes. MATERIAL and METHODS: 237 patients with ischemic stroke admitted to the study between January 2011 and December 2011. Ischemic stroke subtypes were classified according to Bamford classification. Patients admitted in the the beginning of the first 24 hour of disease were included the study. We compare the serum uric acid levels between stroke subgroups and controls. RESULTS: We found increased serum uric acid levels in all stroke patients but the most increased levels were in the posterior circulation infarct group. However this elevation was not statistically significant. CONCLUSION: Future researches should be focus on the pathogenetic mechanism of hyperuricemia as well as examining the role in stroke subtypes especially posterior circulation infarcts.

An unusual cause of pediatric stroke secondary to congenital basilar artery fenestration.

Basilar artery fenestration is an uncommon congenital variant that has been associated with aneurysms and posterior circulation infarcts in the adult literature. Little is known about the functional consequences of basilar artery fenestration, if any, in childhood. We present a case of a previously healthy 12-year-old boy who presented with diplopia, tinnitus, and ataxia who had subtle findings on diffusion-weighted magnetic resonance imaging consistent with posterior circulation territory infarction. Computed tomography angiography and magnetic resonance angiography revealed an area of signal abnormality in the basilar artery, which was confirmed on conventional angiography to be a type 2 basilar artery fenestration, without thrombus or aneurysm. The patient recovered from his neurologic deficits over two days and was placed on prophylactic aspirin therapy without recurrence of symptoms. This rare anatomic variant of the posterior circulation is important for physicians to recognize and may have associated neurologic consequences during childhood worthy of further investigation.

Vertebrobasilar variants and their basic clinical implications

Objectives: Cerebrovascular diseases are the leading illness affecting the modern world with a high mortality rate. The posterior circulation of the brain consists of vertebrobasilar system, shows a high incidence of anomalies in the form of hypoplasia, fenestrations and asymmetry of the vessels, which precipitate the development of vertebrobasilar insufficiency and posterior circulation stroke. A detailed knowledge of the vertebrobasilar variants is essential in the diagnosis, treatment as well as in educating the patients suffered fro m posterior circulation stroke. The present study is aimed to analyze the size, asymmetry and anomalies of the vertebrobasilar system and their implications in posterior circulation infarcts. Materials and methods: Fifty adult brains were studied during routine dissection of the cadavers. The base of the brain with intact vertebral, basilar and posterior cerebral arteries were dissected, preserved in 10% formalin and analyzed for the variations in the size, length and asymmetry in the configuration. The dimensions of the vessels were measured using graduated calipers. Results: Anomalies of the basilar artery were found in 14% of the bra ins, in the form of hypoplasia, fenestration and terminal expansion at its bifurcation . The vertebral arteries showed asymmetry with right vertebral were hypoplastic in majority of the brains . Conclusions: The variations of the vertebrobasilar system increase the risk of vertebrobasilar insufficiency and posterior circulation stroke. Anomalies of the vertebrobasilar arteries were also found to be associated with aneurysms. The right vertebral artery has been frequently hypoplastic and there was no consistent correlation between the left vertebral dominance and right handedness of the person. Hypoplastic vessels were frequently associated with vertebrobasilar territory ischemic stroke .

Characteristics of vascular lesions in patients with posterior circulation infarction according to age and region of infarct.

Patients with posterior circulation infarction underwent CT angiography and magnetic resonance angiography. Intracranial and extracranial vasculopathy was evaluated according to age group and location of stroke. Patients aged > 60 years and < 60 years had similar rates of vertebral artery dominance and vertebrobasilar artery developmental or origin anomalies. Vertebrobasilar artery stenosis or occlusion and tortuosity occurred more frequently in patients aged > 60 years than < 60 years. The rates of vertebrobasilar artery anomalies and tortuosity were high in patients with posterior circulation infarction. Vertebrobasilar artery tortuosity occurred more frequently in patients aged > 60 years, whereas vertebrobasilar artery developmental anomalies occurred with similar frequency in patients aged < 60 years and > 60 years. Patients with infarction of the brainstem or cerebellum were more likely to have vertebral artery stenosis or occlusion, basilar artery stenosis or occlusion, vertebral artery dominance or tortuosity, and basilar artery tortuosity, and patients with infarction of the thalamus, medial temporal, or occipital lobes were more likely to have stenosis or occlusion of the vertebral or basilar arteries. Vertebrobasilar artery tortuosity, vertebral artery dominance (hypoplasia), and congenital variations of the vertebrobasilar system may lead to posterior circulation infarction at different locations in different age groups.

Oxfordshire Community Stroke Project classification but not NIHSS predicts symptomatic intracerebral hemorrhage following thrombolysis

BackgroundThe Oxfordshire Community Stroke Project (OCSP) classification is a simple tool to categorize clinical stroke syndromes. We compared the outcomes of stroke patients after intravenous thrombolysis stratified by the baseline National Institutes of Health Stroke Scale (NIHSS) score or by the OCSP classification. MethodsWe assessed the safety of thrombolysis in consecutive stroke patients who received intravenous thrombolysis within 3h after onset. The patients were grouped by the NIHSS score into mild to moderate stroke (≤20) and severe stroke (>20), and also by the OCSP classification as having total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), posterior circulation infarcts (POCI), or lacunar infarcts (LACI). Symptomatic intracerebral hemorrhage (SICH) was used as the primary outcome. ResultsOf the 145 patients included in the study, 45 had a baseline NIHSS score>20. Their stroke syndromes were as follows: 78 with TACI, 29 with PACI, 16 with POCI, and 22 with LACI. The proportion of SICH was comparable between patients with high or low NIHSS score (11.1% vs. 9.0%, P=0.690). The chance of SICH was highest in patients with TACI (15.4%), followed by LACI (4.5%), PACI (3.4%), and POCI (0%). After adjustment for age, baseline glucose, and use of antiplatelet agents before admission, SICH was significantly increased in patients with TACI relative to those with non-TACI (odds ratio 5.92; 95% confidence interval 1.24–28.33, P=0.026). ConclusionsThe OCSP clinical classification may help clinicians evaluate the risk of SICH following intravenous thrombolysis.

Insular Ischemic Stroke: Clinical Presentation and Outcome

Background: The insula is a small but complex structure located in the depth of the sylvian fissure, covered by the frontal, parietal and temporal operculum. Ischemic strokes limited to the insula are rare and have not been well studied. Our objective is to better define the clinical presentation and outcome of insular ischemic strokes (IIS). Methods: We reviewed the institutional prospective, consecutive stroke database from two centers to identify patients with IIS seen between 2008 and 2010. We also searched the Medline database using the keywords insula(r), infarction and stroke to identify previously published IIS cases confirmed by MRI. Minimal extension to an adjacent operculum or subinsular area was accepted. Clinicoradiological correlation was performed by distinguishing IIS involving the anterior (AIC) or posterior insular cortex (PIC). We collected clinical, demographic and radiological data. The outcome was determined using the modified Rankin Scale (mRS). Results: We identified 7 patients from our institutions and 16 previously published cases of IIS. Infarcts were limited to the AIC (n = 4) or the PIC (n = 12) or affected both (n = 7). The five most frequent symptoms were somatosensory deficits (n = 10), aphasia (n = 10), dysarthria (n = 10), a vestibular-like syndrome (n = 8) and motor deficits (n = 6). A significant correlation was found between involvement of the PIC and somatosensory manifestations (p = 0.04). No other statistically significant associations were found. IIS presentation resembled a partial anterior circulation infarct (n = 9), a lacunar infarct (n = 2) or a posterior circulation infarct (n = 2). However, most cases presented findings that did not fit with these classical patterns (n = 10). At the 6 month follow up, mRS was 0 in 8/23 (35%) patients, 1–2 in 7/23 (30%) and unknown in 8/23 (35%). Conclusions: IIS presentation is variable. Due to the confluence of functions in a restricted region, it results in multimodal deficits. It should be suspected when vestibular-like or motor but especially somatosensory, speech or language disturbances are combined in the same patient. The outcome of IIS is often favorable. Larger prospective studies are needed to better define the clinical presentation and outcome of IIS.

Reversible cerebral vasoconstriction syndrome: rare or underrecognized in children?

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological diagnosis comprising 'thunderclap' headaches and reversible segmental vasoconstriction of cerebral arteries, occasionally complicated by ischaemic or haemorrhagic stroke. We report a case of RCVS in a 13-year-old male with severe thunderclap headaches and no focal neurological signs. Brain imaging showed multiple posterior circulation infarcts; cerebral computed tomography, magnetic resonance imaging, and catheter angiography showed multifocal irregularity and narrowing, but in different arterial segments. Laboratory studies did not support a diagnosis of vasculitis. Symptoms resolved over 3 weeks; magnetic resonance angiography 3 months later was normal and remained so after 2 years. We highlight the typical clinical features of RCVS in this case and suggest that the diagnosis should be considered in children with thunderclap headaches or stroke syndromes where headache is a prominent feature, especially if cerebrovascular imaging studies appear to be evolving or discrepant.

Posterior Versus Anterior Circulation Infarction

Distinguishing between symptoms of posterior circulation infarction (PCI) and anterior circulation infarction (ACI) can be challenging. This study evaluated the frequency of symptoms/signs in the 2 vascular territories to determine the diagnostic value of particular symptoms/signs for PCI. Neurological deficits were reviewed and compared from 1174 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. The diagnostic value of specific symptoms/signs for PCI was determined by measuring their sensitivity, specificity, positive predictive value (PPV), and the OR. Homolateral hemiplegia (PCI, 53.6% versus ACI, 74.9%; P<0.001), central facial/lingual palsy (PCI, 40.7% versus ACI, 62.2%; P<0.001), and hemisensory deficits (PCI, 36.4% versus ACI, 34.2%; P=0.479) were the 3 most common symptoms/signs in PCI and ACI. The signs with the highest predictive values favoring a diagnosis of PCI were Horner's syndrome (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), crossed sensory deficits (3.0% versus 0%; P<0.001; PPV=100.0%; OR=3.98), quadrantanopia (1.3% versus 0%; P<0.001; PPV=100.0%; OR=3.93), oculomotor nerve palsy (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), and crossed motor deficits (4.0% versus 0.1%; P<0.001; PPV=92.3%; OR=36.04); however, all had a very low sensitivity, ranging from 1.3% to 4.0%. This study indicates that the symptoms/signs considered typical of PCI occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate PCI from ACI. Neuroimaging is vital to ensure accurate localization of cerebral infarction.

Incidence of post‐stroke delirium and 1‐year outcome

Post-stroke delirium is not uncommon, and is associated with poorer outcome, higher mortality, longer hospital stay and greater risk of post-stroke dementia. We aim to identify the incidence of post-stroke delirium, risk factors for its development and 1-year outcome. Consecutive patients aged >50 years admitted to the acute stroke unit were recruited. Baseline demographic data, types of stroke, location of infarct, etiology of stroke, premorbid cognitive impairment, living arrangement, comorbidity, drug history and biochemical parameters were collected. Delirium was screened by the Confusion Assessment Method. Outcome data included length of stay, mortality, functional mobility, and placement on discharge 6 months and 12 months post-stroke. A total of 314 patients with a mean age of 72.9 years were recruited. Of those patients, 86 (27.4%) had delirium. Age (OR 1.05), presence of acute urinary retention (OR 7.67), chest infection (OR 22), National Institutes of Health Stroke Scale (OR 1.13), total anterior circulation infarct (OR 18.8), posterior circulation infarct (OR 3.52) and pre-existing cognitive impairment (OR 2.51) were independent predictors of post-stroke delirium. Patients with delirium had more functional disability, a higher proportion went to a nursing home on discharge (62% vs 11.2%), at 6 months (60% vs 12.5%) and at 12 months (65% vs 13%), and there was higher inpatient mortality (18% vs 2.2%) and 1-year mortality (30% vs 7.4%). Hospital stay was also longer (45 vs 22 days). Delirium is a common complication post-stroke, with treatable risk factors. It results in higher functional impairment, nursing home placement and mortality. Comprehensive geriatric assessment of older stroke patients might help to reduce the occurrence of delirium.