ICMR
 arrow Health Care of the Rural Aged Books

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.

-K. Srinivasan

CARDIOVASCULAR SYSTEM

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.

I. Hypertension

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 population.

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 aldosteronism.

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.

<<Back | Index | Next>>