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Background: Telemedicine is increasingly being used in acute stroke care. Some of the first studies and network projects are already applying remote audiovisual communication for patient evaluation. Formerly the telephone was the method of choice to contact experts for case discussion. We compared remote video-examination and telephone consultation in acute stroke care., Methods: Two district hospitals were linked to stroke centers in Northern Bavaria. Patients with symptoms suggestive of an acute stroke were included. Remote video examination (RVE) was provided by live audiovisual communication and access to brain images; telephone consultation (TC) was done via standard telephone using a structured interview. There was a weekly rotation of the two methods. Demographic data and other data concerning process and quality of care as well as outcome 10 days after stroke were recorded and compared between the two groups., Results: Within the study period 151 consultations were made in acute stroke patients (mean age 66.8 years). 77 patients were seen by RVE and 74 by TC. Total examination times were 49.8 min for RVE and 27.2 min for TC (p < 0.01). Patients were more frequently transferred to the stroke center after TC consultation (9.1 % vs. 14.9 %, p < 0.05) and had a higher mortality 10 days after stroke (6.8 % vs. 1.3 %, p < 0.05). Diagnosis made by TC had to be corrected more frequently (17.6 % vs. 7.1 %; p < 0.05)., Conclusions: Creating a network improves stroke care by establishing cooperation between hospitals. Telephone consultation could be a simple method of telemedicine to support cooperation as it is easy and widely available. However, outcome parameters like mortality indicate that remote video examination is superior to TC. Therefore, full-scale audiovisual communication is recommended for remote consultation in acute stroke care.

Background: Elective programs for medical students in the last year of their university training are poorly evaluated. The goal of this study was to determine the gain in theoretical and practical skills in a group of students during their elective in neurology. Students were trained by either conventional teaching methods or applying improved problem-based teaching., Method: A test of 78 multiple choice questions regarding both, theoretical and practical aspects of clinical neurology, was presented to 21 students (9 female, 12 male). This group of students (group A) was trained according to the conventional teaching method. A subsequent group of students (intervention group B; n = 19; 9 female; 10 male) was educated using a modified teaching method that consisted of more problem-based learning, gathering experience with neurosonological and neurophysiological principles and in intense bedside teaching. The test was performed at the beginning and end of their elective period. The percentage increase in the tests was taken as the primary endpoint. In addition, all students were asked about their degree of satisfaction with the elective in general., Results: Students of both groups did not differ with regard to age, gender, number of semesters, score of last examination and score of the test at the beginning of the elective. However, students who participated in the problem-based teaching group (group B) performed significantly better in the test at the end of the elective (increase 16.3% +/- 15.5) than those who were trained according to the conventional teaching program (percentage increase 6.3% +/- 9.4; p = 0.017). Students of both groups were highly satisfied with the elective in general., Conclusion: More problem-based teaching including practical exercises and intense bed-side teaching significantly improved students' performance. Thus, adaptation of teaching covering these aspects should be encouraged and might improve the neurological knowledge and skills of the students.

Hepatitis C virus (HCV) infection is often associated with abnormal immunological responses. We describe four patients with vasculitic neurological signs and symptoms following HCV infection. A 56-year-old woman with HCV infection developed peripheral neuropathy characterized by asymmetric distal painful hypesthesia, dysesthesia and moderate motor weakness of the lower limbs. Serological examinations revealed cryoglobulinemia and low levels of complement C4. A biopsy of the sural nerve revealed vasculitic neuropathy. HCV infection associated immunomediated vasculitis was diagnosed. While steroid therapy was ineffective, treatment with interferon-alpha improved the neuropathy considerably without, however, eliminating HCV infection. A 62-year-old man with HCV infection developed peripheral sensory neuropathy. Complement C3 was slightly diminished. Nerve biopsy revealed vasculitic neuropathy. A 71-year-old woman developed chronic symmetric sensomotor polyneuropathy. HCV hepatitis followed blood transfusions. Cryoglobulins tested positive, consistent with type II cryoglobulinemia. Complements C3 and C4 were diminished. Inflammatory infiltrates in the sural nerve biopsy specimen led to the diagnosis of chronic vasculitic disorder. A 55-year-old woman with HCV infection developed vasculitis of the skin, connective tissue, visceral organs, and kidney, leading to hemodialysis. Neurologically she developed severe apathy and drowsiness, myoclonic jerks, exaggerated deep tendon reflexes, and positive pyramidal signs. Magnetic resonance imaging of the brain showed diffuse increased signal abnormalities involving supra- and infratentorial white matter suggesting cerebral vasculitis. Cryoglobulins were positive, complements C3 and C4 slightly diminished (54 mg/dl, 4.3 mg/dl). Supportive therapy resulted in neurological improvement. Treatment with interferon-alpha was discontinued because of agranulocytosis. In patients with peripheral neuropathy or signs of leucencephalopathy, a hepatitis C associated vasculitis should be considered in the differential diagnosis.