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We determined the incidence, risk factors, and short-term mortality of stroke in a well-defined area of southern Italy, i.e. the city of Vittoria, Sicily (58 833 inhabitants). The medical records of the local hospitals and the outpatient files of the local neurologist referring to the calendar year 1991 were retrospectively investigated. Stroke was defined according to standard criteria and classified as first-ever (FE) and recurrent (R). Risk factors for stroke were diagnosed from medical history, laboratory and instrumental findings, and in the presence of specific treatments. Short-term mortality was assessed as 30-day case-fatality rate. The sample included 120 cases (61 men) aged 34-94 years, 89 of whom (48 men) had a FE stroke. The overall annual crude incidence rate of FE stroke was 165.3 per 100 000 (men, 178.4; women 152.2); for FE and R stroke together it was 222.9 (men, 226.8; women 219.1). The standardized rates were 245.3 (FE stroke) and 321.9 (FE and R stroke). The age-specific rates for FE stroke were 9.4 (<55 years), 262.2 (55-64 years), 645.2 (65-74 years), 2019.7 (75-84 years), and 3246.8 (≥85 years). The corresponding values for FE and R stroke were 11.7, 412.0, 887.1, 2565.5, and 4220.8. In patients with FE stroke, cerebral infarction was the main type. Hypertension, diabetes and cardiac disorders were the commonest risk factors, with similar distribution among FE and R stroke. The 30-day case-fatality rate was 28% for FE and R stroke and 38% for FE stroke. Compared to other reports, the incidence of stroke in Vittoria was lower in the youngest but higher in the oldest age groups. Although the small sample size and possibility of misdiagnoses may partly explain our findings, the roles of different dietary, social, and genetic factors in the local population warrant investigation. [ABSTRACT FROM AUTHOR]

Sneddon's syndrome is a rare vascular disease affecting mainly skin and brain arterioles leading to their occlusion due to excessive endothelial proliferation. The two main features of this syndrome are livedo reticularis and lacunar subcortical infarcts. Here, we describe the case of a 64-year-old woman presenting with a 4-year history of a throbbing, bilateral, parieto-occipital headache associated with facial pain, but without any other accompanying symptom. The pain, initially misdiagnosed as atypical trigeminal neuralgia, worsened up to chronic daily and such severely disabling headache that she was constrained to bed. She presented with reduced cognitive functions, diffuse and severe livedo reticularis, severe myalgias and mild stiffness. All diagnostic test for different diseases were performed and other diseases excluded except for Sneddon's syndrome. Her symptoms were reduced firstly using acetylsalicylic acid, then ticlopidine 250 mg bid was begun and then Pentoxyphillin, resulting in a significant improvement of symptoms with the disappearance of headache. Her worsening in the first year was characterized by obsessive-compulsive behaviours, body-image misperceptions and panic attacks, improved for a period using olanzapine. Considering this case, we remark the importance of using headache classification to avoid diagnostic errors, secondly, we describe an atypical manifestation of Sneddon's syndrome and therapeutic efficacy of using ticlopidine and pentoxyphillin. [ABSTRACT FROM AUTHOR]