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Background: With improvements in stroke treatments, the number of patients with dramatic recovery is increasing. However, many of them are still complaining of difficulties in returning to work and every day activities. The aim was to assess work and social dysfunctioning in patients with minor to moderate stroke and explore its contributing factors.Methods: Consecutive patients were prospectively included at a median 7 months after a first-ever stroke. Scores on the Work and Social Adjustment Scale (WSAS), a generic self-reported scale for assessing social functioning, were correlated with scores on the National Institutes of Health Stroke Scale (NIHSS), activities of daily living, Hospital Anxiety and Depression scale (HAD) and MMSE, Iowa Scale of Personality Changes and return to work at 1 year.Results: Among the 84 included patients (mean age 43.5 years), 57 (68%; 95% CI 57 to 78%) complained of significant perturbation of functioning attributed to stroke. WSAS was highly significantly related to modified Rankin scale, daily living activities, Iowa Scale of Personality Changes and return to work at 1 year. Using ordinal logistic regression, the contributors to WSAS were initial neurological severity (NIHSS at admission), HAD and MMSE.Conclusions: The study showed that up to 68% of our patients complained of significant work and social dysfunction due to stroke, despite a good clinical outcome. This self-estimation was correlated to external validation criteria, stressing the high burden of stroke from the patient's viewpoint. Moreover, when compared across diseases, social dysfunctioning after mild stroke was as important as in other major disabling diseases. [ABSTRACT FROM AUTHOR]

We report 10 cases of cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA). Axial sections on MRI through the middle of the medulla and the cerebellum showed the infarction as a triangular area with a dorsal base and a ventral apex directed towards the fourth ventricle. The infarct also involved the lateral and dorsal medulla when the mPICA supplied all or part of these regions. Three clinical patterns were observed: 1) pseudolabyrinthine signs with or without dysmetria and ataxia when the medulla was spared; marked axial lateropulsion was present in most cases; 2) complete or incomplete Wallenberg's syndrome, when the medulla was involved; 3) silent infarction. These syndromes are precisely those previously attributed to PICA occlusion without distinction of the branch involved. No alteration of consciousness was recorded and spontaneous recovery was the rule. Cerebellar infarction in the distribution of the mPICA can be regarded as a benign condition with a good prognosis. [ABSTRACT FROM AUTHOR]

Three young women (aged 18 years, 19 years and 19 years) who developed progressive neuropsychic and neurologic disturbances with hearing loss and multifocal retinal artery branch occlusions are reported. This retinocochleocerebral syndrome has been reported previously only in 12 young North American women. Its pathogenesis is unknown, but an atypical viral infection of the vessel walls has been suggested. Abnormalities of T lymphocytes subsets in blood in one of the patients suggested an immunological dysfunction, but all other tests, including immunological reactions on brain and skin biopsies, were negative or non-specific. Steroids and immunosuppressive agents have been advocated on an empirical basis, but the second patient showed a substantial recovery without any therapy and the third gradually deteriorated despite azathioprine, cyclophosphamide, prednisone and plasma exchanges. This retinocochleocerebral syndrome probably corresponds to an arteriolopathy of unknown nature. [ABSTRACT FROM AUTHOR]

Clinical and biochemical effects of Gamma-vinyl-Gaba (GVG) have been evaluated in a blind video-controlled study in 10 psychiatric patients (mean age 71 yr) with tardive dyskinesia. CSF free and total Gaba and homocarnosine concentrations increased from three to five fold with GVG treatment. Despite the GVG-induced biological effects on Gaba metabolism, GVG did not consistently improve tardive dyskinesia. Psychomotor side-effects occurred in older patients, who only tolerated GVG dosages of 2-4 g/day. [ABSTRACT FROM AUTHOR]

The article focuses on an ideal model for stoke services. Stroke programs have a vital role to play in educating the public and primary physicians. Since their first development in the 1970s, the clinical effectiveness of stroke units has been demonstrated in many randomized controlled studies and meta-analyses. If the Calgary stroke model could be beneficial for patients and financially efficient for the hospital, it describes the course of individual patients and represents just one link in the vertical healthcare network. The global aim of this vertical part of the network is to provide emergency care while optimizing medical management, reducing patient length-of-stay, as well as the prevention of recurrent stroke to minimize the impact of stroke.

Background and Aims: Social functioning is impaired in approximately two-thirds of stroke patients of vocational age, even several months after a first ever mild to moderate stroke. The known predictors of social functioning are initial stroke severity, anxiety and depression, and the Mini-Mental State Evaluation, suggesting that cognitive deficits contribute to post-stroke social dysfunctioning. The aim of this study was to evaluate whether cognitive domains correlated with social functioning and to determine the cognitive predictors of social dysfunctioning., Methods: 74 patients were prospectively included 6 months after a first ever stroke. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale, depression and anxiety were recorded. Social functioning was recorded using the Work and Social Adjustment Scale (WSAS). An extensive neuropsychological test battery explored general cognitive functioning, episodic memory, instrumental functions, executive functions and working memory. Univariate comparisons assessed the relationships between the neuropsychological tests and scores on the WSAS. Predicting factors for WSAS were determined using ordinal logistic regression., Results: 52 patients (70%; 95% confidence interval 58% to 80%) complained of significant perturbations in work and social functioning. In univariate comparisons, general cognitive functioning, memory, instrumental functions, executive functions and working memory significantly correlated with social functioning. Working memory was the most affected domain. With multivariate modelling, the NIHSS at admission, Hospital Anxiety Depression scale and Owen's Spatial Working Memory test were independent predictors of WSAS., Conclusions: All cognitive domains were associated with social functioning, working memory being the main cognitive determinant. Our results suggest that cognitive impairment impacts on social dysfunctioning, which is known to be a component of quality of life.