Iwamoto T, Akazawa M, Ami M, Shimizu T, Umahara T, Takasaki M
Department of Geriatrics, Tokyo Medical University.
Nihon Ronen Igakkai Zasshi. 1999 Aug;36(8):565-71. doi: 10.3143/geriatrics.36.565.
Five elderly patients (> or = 65 y) with cerebral infarction induced by dehydration during a heat wave were described to clarify the relationship between dehydration and stroke in the aged. When the daily maximum temperature exceeded 30 degrees C every day for two weeks, 6 patients with acute stroke came to our hospital. Five of them were patients with cerebral infarction aged 73-89 (the elderly group) and one was a 52-year-old woman with putaminal hemorrhage. As control groups, patients with ischemic stroke during the period 4 weeks before and after, but excluding the heat wave period, which consisted of an elderly control group (n = 7) and a young control group (n = 5), were also studied retrospectively with regard to clinical findings and neuroimaging. The incidence of cerebral infarction in the elderly group was higher in the heat wave period among all three groups. Atherothrombotic, lacunar, and cardioembolic infarctions were seen in 1, 2 and 2 cases, respectively. The onset in the elderly group was characteristic as all occurred before noon and were related to exercise. Physical examination at arrival revealed decreased skin turgor and dry tongue. A high BUN/creatinine ratio (> or = 25) and elevated fibrinogen (> 400 mg/dl) was frequently noted, although high hematocrit (> or = 45) was not seen. According to clinical findings, dehydration was diagnosed and they were infused with fluid, resulting in the improvement of skin turgor and tongue moisture. These findings indicated that dehydration due to excess perspiration due to the heat wave induced cerebral infarction in the elderly. It suggests that water intake on awakening in summer is important to prevent dehydration and ischemic stroke because elderly people are especially susceptible to those conditions in the morning.
描述了5例（年龄≥65岁）在热浪期间因脱水诱发脑梗死的老年患者，以阐明脱水与老年人中风之间的关系。当每日最高气温连续两周每天超过30摄氏度时，6例急性中风患者前来我院就诊。其中5例为73 - 89岁的脑梗死患者（老年组），1例为52岁的壳核出血女性。作为对照组，还对热浪期前后4周但不包括热浪期的缺血性中风患者进行了回顾性研究，包括老年对照组（n = 7）和青年对照组（n = 5），分析其临床症状和神经影像学表现。在所有三组中，老年组在热浪期脑梗死的发生率更高。分别有1例、2例和2例出现动脉粥样硬化血栓形成性、腔隙性和心源性栓塞性梗死。老年组发病具有特征性，均发生在中午之前且与运动有关。入院时体格检查发现皮肤弹性降低、舌干。尽管未发现高血细胞比容（≥45），但经常注意到高尿素氮/肌酐比值（≥25）和纤维蛋白原升高（> 400 mg/dl）。根据临床表现诊断为脱水，并给予补液，皮肤弹性和舌湿润度得到改善。这些发现表明，热浪导致出汗过多引起的脱水诱发了老年人的脑梗死。这表明夏季晨起饮水对于预防脱水和缺血性中风很重要，因为老年人在早晨尤其易患这些疾病。
