[First ischemic stroke in the very old: etiology, clinical course and outcome].

This study was designed to investigate the prevalence of risk factors, etiology, clinical course and outcome of the first-ever ischemic stroke in patients aged at least 85 when compared with younger patients with ischemic stroke. We studied 802 patients with first-ever ischemic stroke, including 103 patients at the age of 85 and more, and 699 patients at the age of 60-84. We collected data regarding the prevalence of risk factors, etiology of stroke, severity of neurological deficit and the presence of consciousness disturbances. The major complications were registered and the infarction volume was assessed using computed tomography. Mortality and functional status of the survivors were assessed on the 30th and 90th day after stroke using Barthel Index. Very old patients with ischemic stroke were characterized by greater percentage of women and higher frequency of ischemic heart disease; diabetes, obesity and smoking were all noted less frequently in this group. Very elderly subjects presented more frequently with TACI syndrome (24.3% and 14.6%, respectively; p < 0.05). They had greater neurological deficit in all days of assessment and were more likely to have the consciousness disorders on admission (39% and 22.3%, respectively; p < 0.001). Urinary tract infection was the only major complication more frequently seen in very old subjects (53.4% and 35.3%, respectively; p < 0.05). The studied groups did not differ regarding etiology of stroke, the length of hospital stay and the incidence of other complications. 30th and 90th-day mortality was greater among very elderly subjects (28.1% vs 16.4% and 46.6% vs 24.6%, respectively; both p < 0.05). The disability assessed 30 and 90 days after stroke was also much greater in very old patients. Very old patients with first ischemic stroke have greater neurological deficit, worse functional status and greater mortality after stroke. They are more likely to have ischemic heart disease and less likely to have diabetes or obesity. The causes of stroke, incidence of complications (with the exception of urinary tact infections), size of the lesion and length of hospital stay are similar in very old and younger patients with stroke.