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We describe an MR-based methodology designed to study cerebral haemodynamic compromise in patients with symptomatic carotid occlusions. We present the results of eight patients who underwent MR angiography of the cervical carotids and circle of Willis, MR imaging of the brain and dynamic gadolinium MR perfusion studies before and after the injection of the carbonic anhydrase inhibitor acetazolamide. All patients showed increased transit times in the symptomatic hemisphere at rest indicating reduced flow. The transit time asymmetries became more pronounced after acetazolamide in all patients because of failed vasodilatation on the affected side. There was an inverse correlation between the degree of increased transit time and the degree of collateralisation around the circle of Willis. We believe that demonstration of both macroscopic vascular anatomy and microvascular reserve is important when assessing patients with possible low-flow states and the described method is a robust means of obtaining that data. [ABSTRACT FROM AUTHOR]

In 1997 the EFNS Task Force on Acute Neurological Stroke Care published its recommendations for acute stroke care (Brainin et al. , 1997), which, in 1999, was followed by a stroke care inventory (Brainin et al. , 2000) assessing the development of acute stroke care. In 2000 all 33 members of the EFNS Stroke Scientist Panel were asked to complete a questionnaire on the treatment of acute stroke in their country as of 2000. Data were based either on national surveys or a personal estimate of national practice, together with data from the personal practice of the panel member. Data from 22 countries were received. One of the principal findings is the lack of systematic evidence about practice in a significant number of European countries. Results illustrate that neurologists have a leading role in implementing acute stroke treatment guidelines and in adopting new therapeutic methods in most countries, but there is a wide variation in the application of different therapeutic procedures. [ABSTRACT FROM AUTHOR]

In a prospective study of 200 patients with acute stroke, blood glucose and glycated haemoglobin (HbA1) were measured within 72 hours of onset. Unrecognized hyperglycaemia as defined by a raised stable HbA1 more than two s.d. above the mean reference value and no previous history of diabetes was present in 27%. No correlation existed between patient age and admission blood glucose or HbA1 levels (r = 0.1). Cumulative mortality and recovery of limb function was assessed in the first 136 patients with carotid distribution events. Admission blood glucose greater than or equal to 8 mmol/l was shown to be associated with a significantly greater mortality at 4 and 12 weeks (P less than 0.05). Multivariate analysis with age, glucose, HbA1 as independent variables demonstrated that age was the only significant predictor for death at 4 weeks (P less than 0.05) but at 12 weeks both age and blood glucose were significant (P less than 0.05). In patients less than 65 years blood glucose was a significant predictor for death (P less than 0.05) but in patients less than or equal to 65 years HbA1 and not glucose was significantly (P less than 0.05). Patients greater than or equal to 65 years with HbA1 greater than or equal to 7.5% were significantly more likely to have a raised admission blood glucose. Hyperglycaemia on admission was not shown to influence recovery of limb function. Increasing age is of greatest importance in predicting mortality although blood glucose is of prognostic value especially in the young stroke patient. [ABSTRACT FROM PUBLISHER]

A patient is described who had myeloma of the polymeric IgA variety, together with a striking hyperlipidaemia and xanthomatosis. Investigations into the protein and lipid abnormality failed to demonstrate any mechanism for the hyperlipidaemia. A review of the literature, however, validates this clinical entity and some of the suggested explanations are discussed. [ABSTRACT FROM PUBLISHER]

The effects of isosmolar loads of glucose and saline after onset of focal cerebral ischaemia (middle cerebral artery occlusion) were compared in cats. In cats given saline cerebral blood flow (CBF) fell and then rose slightly on the marginal gyrus (infarct penumbra). There was a sustained fall in CBF on the suprasylvian and ectosylvian gyri (infarct core). Reperfusion restored blood flow to preocclusion levels with no overall postischaemic hypoperfusion. Below ischaemic flows of 14 ml/100 g/min brain specific gravity was reduced in a smaller proportion of gyri by contrast with non reperfused cortex, suggesting that in some gyri resolution of cerebral oedema had taken place. GABA uptake was normal in the infarct core, but was reduced within the ischaemic penumbra. In animals given glucose after occlusion, CBF fell on the marginal gyrus during reperfusion. The degree of resolution of cerebral oedema was less than in saline infused cats. GABA uptake showed a pattern of abnormality similar to that seen in saline infused cats, except that uptake values were lower in the infarct core. Pial surface potassium activity remained elevated in the penumbra following reperfusion in glucose infused cats, but returned to normal in saline infused cats. Implications for the management of cerebral ischaemia in man are discussed. [ABSTRACT FROM AUTHOR]

There is evidence to support the use of naftidrofuryl in acute stroke with claims of increased recovery, reduced fatality and reduced bed occupancy in patients treated with either oral or intravenous preparations. One hundred patients presenting with acute hemisphere stroke (less than 72 hours) were randomized to receive either a new oral formulation of naftidrofuryl or placebo on a double-blind basis. Treatment was given for a total of 12 weeks and patients followed for 26 weeks with serial neurological and functional assessments by a single observer. Cumulative fatality and hospital-bed occupancy were determined at each assessment interval. No significant difference was demonstrated in cumulative fatality, hospital-bed occupancy or recovery of motor function in patients treated with either naftidrofuryl or placebo. There is no evidence from this study to support the use of oral naftidrofuryl in acute stroke. [ABSTRACT FROM AUTHOR]

There is little information available from which normal patterns of recovery from acute stroke can be ascertained. Most attention has been directed towards functional recovery in stroke patients but the neurological basis on which this occurs needs to be documented in a large cohort of patients. One hundred and fifty-seven patients admitted to hospital with a clinical diagnosis of acute stroke were examined daily for up to 28 days to determine the patterns of recovery of limb tone, power and reflexes. Changes in these variables during the first 28 days after stroke are described. [ABSTRACT FROM AUTHOR]

A case of tuberculosis of the colon is described. Attention is drawn to the similarity between this and other inflammatory diseases of the bowel. Colonic tuberculosis is now a rarity even where mycobacterial infection is endemic, and may mimic other inflammatory diseases of the bowel with important consequences for treatment and prognosis. Such a case is now described. [ABSTRACT FROM PUBLISHER]

A 58-year-old woman presented with the classical features of polymyalgia rheumatica. She also had a global dementia; CT scan and EEG showed diffuse cerebral disease. After steroid treatment, the polymyalgia rheumatica and dementia rapidly resolved and the CT scan and EEG became normal. The inter-relationships of the giant cell arteritides are discussed in the light of this report of the association of polymyalgia rheumatica and steroid-responsive diffuse cerebral disease. [ABSTRACT FROM AUTHOR]

A patient with subclinical hypothyroidism who presented with true myotonia is described. There was no evidence that either he or members of his family had dystrophia myotonica or myotonia congenita. Treatment with thyroxine resolved his symptoms completely. [ABSTRACT FROM AUTHOR]

This article focuses on the role of rapid assessment stroke clinic in assessing transient ischaemic attack and minor stroke. The rapid assessment stroke clinic (RASC) was established throughout Great Britain as part of a single point of access for general practitioners to refer patients with suspected transient cerebral or ocular ischaemic attacks (TIA) or recovered non-hospitalised stroke in response to the publication of the National Clinical Guidelines for Stroke and the National Service Framework for Older People. These clinics have significant revenue costs for the National Health Service, and hence the importance of reviewing their process and outcome. Between October 2000 and December 2002, 1460 patients were referred to the RASC. Risk factors for TIA or minor stroke included atrial fibrillation, hypertension, diabetes and hypercholesterolaemia.

Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is approved for use in selected patients with ischaemic stroke within 3 hours of symptom onset. IST-3 seeks to determine whether a wider range of patients may benefit.Design: International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE) trial of intravenous rt-PA in acute ischaemic stroke. Suitable patients must be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracerebral haemorrhage. With 1000 patients, the trial can detect a 7% absolute difference in the primary outcome. With 3500 patients, it can detect a 4.0% absolute benefit & with 6000, (mostly treated between 3 & 6 hours), it can detect a 3% benefit. TRIAL PROCEDURES: Patients are entered into the trial by telephoning a fast, secure computerised central randomisation system or via a secure web interface. Repeat brain imaging must be performed at 24-48 hours. The scans are reviewed 'blind' by expert readers. The primary measure of outcome is the proportion of patients alive and independent (Modified Rankin 0-2) at six months (assessed via a postal questionnaire mailed directly to the patient). Secondary outcomes include: events within 7 days (death, recurrent stroke, symptomatic intracranial haemorrhage), outcome at six months (death, functional status, EuroQol).Trial Registration: ISRCTN25765518. [ABSTRACT FROM AUTHOR]