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Introduction: Our university hospital serves a population of 300 000 inhabitants. Stroke is the leading cause of admission in our department of neurology. In June 2003, when the Emergency Department (ED) was closed in our institution, was created an acute stroke network (ASN), comprising 2 beds of direct admission and thrombolysis in the intensive care unit, and 4 beds dedicated to stroke care in the department of neurology, in which standardized stroke care protocols were implemented., Objective: The aim of this study was to evaluate changes in stroke care related to the creation of the ASN in terms of delays of arrival, imaging, use of intravenous (IV) thrombolysis, and outcome of patients. We conducted a prospective study during 18 months to evaluate characteristics of patients admitted with suspected stroke or transient ischemic attack (TIA) in the newly created ASN and to assess conditions of treatment with IV thrombolysis in terms of safety and efficacy. We also compared the outcome data before and after the creation of the ASN., Methods: For each patient admitted in our hospital for suspected stroke or TIA, were prospectively collected clinical and outcome data (age, mode of transport, delay of arrival after the onset of symptoms (OS), treatment with IV thrombolysis, outcome and discharge). This study was conducted in the ED during six months in 2002, and in the ASN during 18 months, for all patients admitted for stroke., Results: Three hundred and sixty four patients were admitted in the ASN. Emergency medical services (EMS) were used in half of cases for transport, and median delay of admission after the OS was 2h and 52 min. Median delay of imaging was 1 h and 45 min. Seventeen patients (8.5 p. 100 of ischemic stroke patients) were treated with IV thrombolysis, with an initial good outcome in 9 patients, 7 with a dramatic recovery). The main reason for therapeutic abstention for untreated patients admitted in the first 3 hours was a mild deficit with a NIHSS<6. Compared with the previous management in the ED, patients in the ASN were younger, had more severe neurological symptoms, the EMS transport was the main mode of transport (versus used in 17 p. 100 of cases in 2002), and the delay of admission was significantly lower: 2 h 52 versus 5 h 10 (p<0.02). After adjustment on the main predictive factors, only patients with hemorrhagic strokes had a better outcome after the creation of the ASN., Conclusions: Creation of an ASN was associated with a significant decrease of admission and imaging delays, due to a strong collaboration with EMS, and with a better outcome for hemorrhagic stroke patients. Treatment with intravenous thrombolysis in the first 3 hours could be used widely and was efficient and safe. However, the creation of dedicated stroke units for all stroke patients remains necessary to improve quality of care and outcome.

A 62-year-old woman was admitted for a disorder of color vision. This cerebral achromatopsia was isolated, without prosopagnosia, alexia, object agnosia. MRI showed bilateral temporo-occipital infarcts, including lingual and fusiform gyrus. Neuropsychological examination and topographic hypotheses are discussed.

A 64-year-old woman was repeatedly hospitalized for various recurrent clinical signs of central nervous system involvement. The diagnosis of primary Sjögren's syndrome was established 3 years 6 months after the onset of the disease. Sicca symptoms, as well as inflammatory biological abnormalities were absent. Moreover, both lacrymal and salivary gland secretions were affected. A high level of antinuclear antibodies to SSA and SSB was associated with inflammatory lesions in minor salivary glands biopsy samples consistent with the diagnosis of Sjögren's syndrome.

The authors report the retrospective study of a medico-surgical series of 161 patients with intracranial meningiomas, diagnosed over a period of 9 years, with a follow-up period varying from 18 months to 9 years. Out of 185 cases studied, 24 were excluded because information or perspective were inadequate. Of the 161 cases retained, 133 (82.6%) were given surgical treatment and 28 (17.4%) were given conservative treatment because the clinical state was poor or the location was deemed inoperable. The sex ratio was 3 women to 1 man. The average age was 58 years. The most frequent locations were the convexity (27.9%) and the sphenoid ridge (24.7%). Among the clinical signs, apart from the usual general seizures or pyramidal signs should be noted the importance of psychological disorders. The operative mortality rate was 14.3% with a very high peak in the sixth decade, reaching 27%, while it was only 9% in the seventh decade and 13% in those over seventy. The internal sphenoid ridge location had a mortality rate of 31.5%, which is significantly higher than for all the other locations. Quality of survival was identical for all age groups. Complications were mainly seizures, functional deficits and psychological disorders. Recurrences were relatively few (10%), but insufficient lapse of time and the presence of only one malignant meningioma explain the lowness of this figure. The use of scanner was not determinant in our series, neither on the earliness of diagnosis, nor on prognosis, comparison of figures before and since scanning showing no significant differences.

The symptom described as muscle weakness corrected by exercise appears to be part of the recessive form of congenital myotonia, of which it can constitute the dominant clinical manifestation in some cases. This symptom coincides with decrements of the action of potentials to repetitive stimulations in the electromyogram, which may be particularly severe in these same cases. These observations contribute to the modification and precision of the description of the recessive form of Thomsen's disease, but their pathogenicity remains unclear.