Late onset seizure disorder
Focal fits invariably denote a temporal lobe
lesion. Cerebral atherosclerosis is the important cause for
late onset seizure disorder. Hypoglycaemia and metabolic defects
can lead onto seizures in the elderly. The various neurological
signs should be watched for. Mysoline is the drug of choice,
gardenal is always to be avoided.
Diabetes causes cranial nerve palsy, diabetic
'pseudotabes', gangrene and peripheral neuropathy. The peripheral
neuropathy in diabetes mellitus may be motor or autonomic.
In the motor type, wasting of thigh muscles occurs. Autonomic
neuropathy is characterised by sinus arrhythmia, lack of sweating,
postural hypotension and dry skin. In diabetic pseudotabes
pupils are not involved.
Nutritional neuropathy is another type of
peripheral neuropathy occurring in the elderly.
THE LECTURE LASTED FOR TWO HOURS DIVIDED
INTO 2 SESSIONS. A CASE OF DEMENTIA, COUPLE OF CASES OF PERIPHERAL
NEUROPATHY, TWO CASES OF EPILEPSY, A CASE RECOVERING FROM
STROKE AND A CASE OF HEADACHE WERE DEMONSTRATED.
Hypertension and Ischemic heart diseases
are the commonest cardiovascular illnesses occurring in old
age. Very often they occur together and are associated with
diabetes and atherosclerosis.
The WHO has defined 'hypertension' as a state
in which systolic pressure is 150 mm of Hg or more and diastolic
pressure is 95 mm of Hg or more. Normal blood pressure varies
according to age. In those aged 60 and above, the normal values
are higher than the WHO values for all age groups.
Higher readings of BP may be in both systolic
and diastolic pressure or in systolic pressure alone. The
systoIic hypertension is also to be treated and it has been
shown that males with systolic hypertension alone have 2½
fold increase in cardiovascular mortality rates, than normal
Hypertension occurring and detected for the
first time in the geriatric population is more likely to be
secondary type than in middle aged persons.
Pyelonephritis, which may be due to obstructive
nephropathies such as enlarged prostate, and tuberculosis
of kidney are two common conditions giving rise to secondary
hypertension. Other illness giving rise to secondary hypertension
include Cushing's syndrome, phaeochromocytoma and primary
Many patients with hypertension have no symptoms
referrable to elevation of blood pressure and are identified
only in the course of physical examination. When symptoms
are present they may be related to (1) elevated pressure itself,
(2) the hypertensive vascular disease and (3) the underlying
disease in secondary hypertension.