Skip to main content Accessibility help
  • Print publication year: 2014
  • Online publication date: January 2014

18 - Neurological emergencies in the elderly

from Section 3 - Systems


1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics – 2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.
2. Pare JR, Kahn JH. Basic neuroanatomy and stroke syndromes. Emerg Med Clin North Am. 2012;30(3):601–15.
3. Muangpaisan W, Hinkle JL, Westwood M, Kennedy J, Buchan AM. Stroke in the very old: clinical presentations and outcomes. Age Aging. 2008;37(4):473–5.
4. Di Carlo A, Lamassa M, Pracucci G, et al. Stroke in the very old: clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group. Stroke. 1999;30(11):2313–19.
5. Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655–711.
6. Nentwich LM, Veloz W. Neuroimaging in acute stroke. Emerg Med Clin North Am. 2012;30(3):659–80.
7. Jauch EC, Cucchiara B, Adeoye O, et al. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl. 3):S818–28.
8. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–7.
9. Hemphill JC, 3rd, Lyden P. Stroke thrombolysis in the elderly: risk or benefit? Neurology. 2005;65(11):1690–1.
10. Longstreth WT, Jr, Katz R, Tirschwell DL, Cushman M, Psaty BM. Intravenous tissue plasminogen activator and stroke in the elderly. Am J Emerg Med. 2010;28(3):359–63.
11. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.
12. Sylaja PN, Cote R, Buchan AM, Hill MD. Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study. J Neurol Neurosurg Psychiatr. 2006;77(7):826–9.
13. Mishra NK, Ahmed N, Andersen G, et al. Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive. BMJ. 2010;341:c6046.
14. Pundik S, McWilliams-Dunnigan L, Blackham KL, et al. Older age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke. J Stroke Cerebrovasc Dis. 2008;17(5):266–72.
15. Del Zoppo GJ, Saver JL, Jauch EC, Adams HP, Jr. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40(8):2945–8.
16. Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for health care professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40(6):2276–93.
17. Rothwell PM, Warlow CP. Timing of TIAs preceding stroke: time window for prevention is very short. Neurology. 2005;64(5):817–20.
18. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6(12):1063–72.
19. Wu CM, McLaughlin K, Lorenzetti DL, et al. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167(22):2417–22.
20. Kleindorfer D, Panagos P, Pancioli A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke. 2005;36(4):720–3.
21. Heyman A, Wilkinson WE, Hurwitz BJ, et al. Risk of ischemic heart disease in patients with TIA. Neurology. 1984;34(5):626–30.
22. Siket MS, Edlow JA. Transient ischemic attack: reviewing the evolution of the definition, diagnosis, risk stratification, and management for the emergency physician. Emerg Med Clin North Am. 2012;30(3):745–70.
23. Moreau F, Jeerakathil T, Coutts SB, FRCPC for the ASPIRE Investigators. Patients referred for TIA may still have persisting neurological deficits. Can J Neurol Sci. 2012;39(2):170–3.
24. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363(9413):915–24.
25. Johnston SC, Nguyen-Huynh MN, Schwarz ME, et al. National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol. 2006;60(3):301–13.
26. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344(19):1450–60.
27. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38(6):2001–23.
28. Weigele JB, Hurst RW. Neurovascular emergencies in the elderly. Radiol Clin North Am. 2008;46(4):819–36, vii.
29. Nentwich LM, Goldstein JN. Intracerebral hemorrhage. In Vascular Emergencies, ed. Rogers RL, Scalea T, Wallis L, Geduld H (Cambridge: Cambridge University Press, 2013), pp. 18–29.
30. Lee WC, Joshi AV, Wang Q, Pashos CL, Christensen MC. Morbidity and mortality among elderly Americans with different stroke subtypes. Adv Ther. 2007;24(2):258–68.
31. Steiner T, Kaste M, Forsting M, et al. Recommendations for the management of intracranial haemorrhage – part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006;22(4):294–316.
32. Runchey S, McGee S. Does this patient have a hemorrhagic stroke? Clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA. 2010;303(22):2280–6.
33. Morgenstern LB, Hemphill JC, 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41(9):2108–29.
34. Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369(9558):293–8.
35. Kidwell CS, Chalela JA, Saver JL, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004;292(15):1823–30.
36. Ginde AA, Foianini A, Renner DM, Valley M, Camargo CA, Jr. Availability and quality of computed tomography and magnetic resonance imaging equipment in US emergency departments. Acad Emerg Med. 2008;15(8):780–3.
37. Singer OC, Sitzer M, du Mesnil de Rochemont R, Neumann-Haefelin T. Practical limitations of acute stroke MRI due to patient-related problems. Neurology. 2004;62(10):1848–9.
38. Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56(6):766–72.
39. Zahuranec DB, Brown DL, Lisabeth LD, et al. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007;68(20):1651–7.
40. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354(4):387–96.
41. Sedat J, Dib M, Rasendrarijao D, et al. Ruptured intracranial aneurysms in the elderly: epidemiology, diagnosis, and management. Neurocrit Care. 2005;2(2):119–23.
42. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. 2000;342(1):29–36.
43. Connolly ES, Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.
44. Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil. 2006;21(6):544–8.
45. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54(10):1590–5.
46. Hukkelhoven CW, Steyerberg EW, Rampen AJ, et al. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg. 2003;99(4):666–73.
47. Decuypere M, Klimo P Jr. Spectrum of traumatic brain injury from mild to severe. Surg Clin North Am. 2012;92(4):939–57, ix.
48. Holmes JF, Hendey GW, Oman JA, et al. Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning. Am J Emerg Med. 2006;24(2):167–73.
49. Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6.
50. Haydel MJ, Preston CA, Mills TJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5.
51. Mower WR, Hoffman JR, Herbert M, et al. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005;59(4):954–9.
52. Mack LR, Chan SB, Silva JC, Hogan TM. The use of head computed tomography in elderly patients sustaining minor head trauma. J Emerg Med. 2003;24(2):157–62.
53. Zink BJ. Traumatic brain injury outcome: concepts for emergency care. Ann Emerg Med. 2001;37(3):318–32.
54. Mosenthal AC, Lavery RF, Addis M, et al. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52(5):907–11.
55. Gaetani P, Revay M, Sciacca S, et al. Traumatic brain injury in the elderly: considerations in a series of 103 patients older than 70. J Neurosurg Sci. 2012;56(3):231–7.
56. Rakier A, Guilburd JN, Soustiel JF, Zaaroor M, Feinsod M. Head injuries in the elderly. Brain Inj. 1995;9(2):187–93.
57. Badjatia N, Carney N, Crocco TJ, et al. Guidelines for pre-hospital management of traumatic brain injury, 2nd ed. Prehosp Emerg Care. 2008;12(Suppl. 1):S1–52.
58. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(Suppl. 1):S1–106.
59. Calland JF, Ingraham AM, Martin N, et al. Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl. 4):S345–50.
60. Gavazzi G, Krause KH. Aging and infection. Lancet Infect Dis. 2002;2(11):659–66.
61. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364(21):2016–25.
62. Lai WA, Chen SF, Tsai NW, et al. Clinical characteristics and prognosis of acute bacterial meningitis in elderly patients over 65: a hospital-based study. BMC Geriatr. 2011;11:91.
63. Cabellos C, Verdaguer R, Olmo M, et al. Community-acquired bacterial meningitis in elderly patients: experience over 30 years. Medicine (Baltimore). 2009;88(2):115–19.
64. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Community-acquired bacterial meningitis in older people. J Am Geriatr Soc. 2006;54(10):1500–7.
65. van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354(1):44–53.
66. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23(3):467–92.
67. van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351(18):1849–59.
68. Tompkins M, Panuncialman I, Lucas P, Palumbo M. Spinal epidural abscess. J Emerg Med. 2010;39(3):384–90.
69. Pope JV, Edlow JA. Avoiding misdiagnosis in patients with neurological emergencies. Emerg Med Int. 2012;2012:949275.
70. Kulchycki LK, Edlow JA. Geriatric neurologic emergencies. Emerg Med Clin North Am. 2006;24(2):273–98, v–vi.
71. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355(19):2012–20.
72. Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med. 1948;239(23):845–54.
73. Davis DP, Wold RM, Patel RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004;26(3):285–91.
74. Sander JW, Hart YM, Johnson AL, Shorvon SD. National General Practice Study of Epilepsy: newly diagnosed epileptic seizures in a general population. Lancet. 1990;336(8726):1267–71.
75. Hauser WA. Seizure disorders: the changes with age. Epilepsia. 1992;33(Suppl. 4):S6–14.
76. Verellen RM, Cavazos JE. Pathophysiological considerations of seizures, epilepsy, and status epilepticus in the elderly. Aging Dis. 2011;2(4):278–85.
77. Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49(Suppl. 1):8–12.
78. Poza JJ. Management of epilepsy in the elderly. Neuropsychiatr Dis Treat. 2007;3(6):723–8.
79. Ramsay RE, Rowan AJ, Pryor FM. Special considerations in treating the elderly patient with epilepsy. Neurology. 2004;62(5 Suppl. 2):S24–9.
80. Stephen LJ, Brodie MJ. Epilepsy in elderly people. Lancet. 2000;355(9213):1441–6.
81. Brodie MJ, Kwan P. Epilepsy in elderly people. BMJ. 2005;331(7528):1317–22.
82. Brodie MJ, Elder AT, Kwan P. Epilepsy in later life. Lancet Neurol. 2009;8(11):1019–30.
83. Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med. 1998;338(14):970–6.
84. de Assis TM, Costa G, Bacellar A, Orsini M, Nascimento OJ. Status epilepticus in the elderly: epidemiology, clinical aspects and treatment. Neurol Int. 2012;4(3):e17.
85. Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10(10):922–30.
86. Lowenstein DH. The management of refractory status epilepticus: an update. Epilepsia. 2006;47(Suppl. 1):35–40.
87. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.