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Background: Deep vein thrombosis (DVT) is an important complication of stroke. Guidelines recommend that DVT prophylaxis should be guided by an assessment of the individual patient's risk. The authors aimed to develop and test models to predict DVT risk., Methods: The Clots in Legs Or sTockings after Stroke (CLOTS) Trial 1 randomised 2518 immobile patients with acute stroke to thigh-length graduated compression stockings (GCS) or no GCS and CLOTS Trial 2 randomised 3114 to thigh-length or below-knee GCS. The authors collected potential predictive variables at baseline and detected DVTs with compression duplex ultrasound scans at about 7-10 days and 25-30 days. The authors developed models with logistic regression to predict DVT in 1242 Trial 2 patients who had two scans and tested the models in the 1422 Trial 1 patients with two scans by estimating the area under the receiver operating characteristic curve (AUC)., Results: 168 (11.8%) patients in Trial 1 and 122 (9.8%) in Trial 2 had proximal DVTs. A model based on the Trial 2 cohort contained four of the 12 baseline variables: dependent before stroke (OR=3.62, 95% CI 2.15 to 6.08), unable to lift arms off bed (OR 1.89, 95% CI 1.23 to 2.90), history of DVT/pulmonary embolism (OR 3.69, 95% CI 1.98 to 6.88) and diabetes (OR 0.55, 95% CI 0.30 to 0.99). The AUC in the development cohort was 0.65 but only 0.57, 95% CI (0.53 to 0.61) in the Trial 1 cohort, indicating poor discrimination., Conclusions: Unfortunately, models based on clinical factors alone discriminate poorly between immobile patients with stroke at high and low risk, and would not facilitate individual tailoring of DVT prophylaxis strategies.

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.

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.

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.