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A 41 year old woman with a transverse section syndrome at the level of C2–3 was found on radiological examination to have an aneurysm of the cervical portion of the right vertebral artery and a thrombosis of the homolateral subclavian artery.

The clinical course and prognosis of 282 cases of acute post-traumatic coma have been studied. Death occurred in 140 cases (49 percent), and, of survivors, about two-thirds achieved complete social reintegration, while one-third were partially reintegrated or not at all. The quality of survival did not depend only on the nature of the physical sequelae, but also on other factors, particularly social ones. With regard to early prognosis, the authors believe it is possible to predict the final outcome of the patient by using the indices of age, level of coma, and the nature of the intracranial lesions.

The incidence of stroke among inpatients is not known. The aim of our study was to investigate the incidence of stroke not preceded by evident iatrogenic factors such as surgical or medical procedures in a cohort of inpatients in a large Italian general hospital. From January 1, 1992, to December 31, 1992, we evaluated patients referred to our neurology department with a suspected diagnosis of stroke that occurred during hospitalization. Patients presenting with stroke as a complication of iatrogenic causes were excluded. We calculated the incidence rate of first-ever stroke in our cohort (crude and among patients aged older than 50 years), thereafter adjusting these rates for age to the general population of the city district of Bologna (Italy). In 1992, 22 inpatients had a first-ever stroke with no evidence of iatrogenic factors. The crude stroke incidence rate was 11.08/1000 per year (95% confidence interval, 6.95 to 16.73). The age-adjusted rate was 5.46 (95% confidence interval 3.42 to 8.24). The incidence rate of first-ever stroke among hospitalized patients is higher than those reported in community-based studies. Higher frequency of coronary artery disease among our patients could explain our findings. Further studies are needed to identify possible predisposing factors (individual or environmental) for stroke among inpatients.