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Few patients with acute cerebral infarction are medicated with thrombolysis as yet. Thus, a specific plan was created in the area of Bergamo in Northern Italy to increase the number of procedures. The plan, started in 2010, consisted of: (1) subdivision of the area of Bergamo into three zones, each one served by a single Stroke-Unit (SU) licensed to thrombolysis; (2) information to population via newspapers and local broadcasting; and (3) teachings both to personnel of Emergency Medical Service and General Practitioners. Here, we have compared the results of the SU of Policlinico San Marco in the years 2008-2009 versus those in the years 2010-2011. During 2008 and 2009, SU admitted 376 acute ischemic strokes, 60 of whom (16 %) within 3 h of the event. Of those patients, 8 (2 %) were treated with thrombolysis. At 3 months of stroke, 61 patients (16 %) were alive and self-independent. During 2010 and 2011, SU admitted 401 acute ischemic strokes, 91 of whom (22 %) within 3 h of stroke. Of those patients, 23 (6 %) were treated with thrombolysis. At 3 months of stroke, 100 patients were alive and self-independent (25 %). The increases of thrombolytic procedures (p = 0.0171), of self-independent patients (p = 0.0036), and of patients arriving within 3 h of stroke (p = 0.0226) were statistically significant. In conclusion, our study shows that a specific plan increases the numbers of thrombolysis and of self-independent patients at 3 months of stroke.

We have evaluated the factors of unsuccessful re-canalisation in a large series of patients with hemispheric cerebral infarction treated with thrombolysis.All patients aged 18-80 years with an acute hemispheric infarction, admitted within the first few hours of symptoms onset, were immediately submitted to Magnetic Resonance both Imaging (MRI) and Angiography (MRA). MRI and MRA were repeated at 24 h of stroke. Re-canalisation was attributed if grade 2 or 3 of Thrombolysis in Myocardial Infarction (TIMI) criteria for the myocardial infarction. Outcome was rated at three months of stroke. Re-canalisation was matched with ageing and with the common risk factors for stroke.One hundred and twenty-one patients, 70 men and 51 women, with a median age of 67 years, were included. Re-canalisation was seen in 62 patients (51%). Twenty-three patients (19%) died by 90 days of stroke. Re-canalisation was associated to survival (1 death vs. 22, p0.0001). Regression analysis retained advanced age (Odds ratio 0.37, 95% Confidence interval 0.13-0.98), baseline National Institute of Health Stroke Scale (NIHSS) (Odds ratio 0.94, 95% Confidence interval 0.89-0.98) and diabetes mellitus (Odds ratio 0.28, 95% Confidence interval 0.09-0.84) as factors contrasting re-canalisation.Our study indicates that in patients with proven occlusion of the terminal segment of the internal carotid artery and/or of the mainstem of the Middle Cerebral Artery, re-canalisation at 24 h of the acute ischemic stroke is dramatically associated with survival, and halted by advanced age and diabetes mellitus.

Background: Although thought to be involved in the precipitation of the acute ischemic stroke, C-reactive protein (CRP) was scarcely investigated in the first few hours of a cerebral infarction. Patients and methods: CRP was measured in a consecutive series of patients within the first 3 h of the onset of a first-ever acute cerebral infarction, and in control inpatients, matched for sex and age (±2 years). Results: Three hundred eighty-seven stroke patients and 387 controls were enrolled. There were 215 men and 172 women in each group. Mean age was 66 years for both. CRP was significantly higher in stroke patients (median 5.0 mg/L, interquartile range [IQR] 2.0–10.0) than controls (median 1.9 mg/L, IQR 0.7–3.9), p < .0001. CRP remained a variable independently associated with stroke in the multiple logistic regression model. Conclusions: CRP appears to be significantly increased already in the first 3 h because of the acute ischemic stroke.

The objective of this study is to investigate relationship between migraine and cerebral infarction in young people. Patients aging 16-44 years, referred for stroke and age- and gender-matched controls were investigated for migraine following the International Headache Society criteria. Included people were 314 strokes and 314 controls. Each group consisted of 150 men and 164 women. Of the 105 persons with migraine (16.7%), 57 had migraine with aura (9.1%). In women, migraine with aura was related to stroke [35 women among strokes (21.3%) vs. 9 among controls (5.5%), P < 0.0001], whereas migraine without aura was not. After multivariate analysis, migraine with aura remained independently associated with stroke together with hypertension, and the estro-progestinic utilization. In men, migraine was not associated with stroke. In conclusion, migraine with aura appears to be associated with ischemic stroke in young women, independently from other common risk factors.

We have sought to relate C-reactive protein (CRP), a peripheral marker of inflammation frequently elevated in stroke patients, with aetiology and prognosis of acute cerebral infarction. Patients were included after a first-ever CT/MR documented cerebral infarction. CRP was measured from blood samples taken within the 6th hour of the onset. Titres of C-reactive protein were stratified in quartiles. Aetiology of stroke was from TOAST criteria. Prognosis was mortality within 14 days of stroke. The study included 648 stroke patients. They were 335 women and 313 men, with a mean age of 70.3 years (median 72). CRP quartiles were mostly increased in cardioembolic strokes, After logistic regression analysis CRP remained an independent factor of 14-day mortality. Our study suggests that in the acute phase of the cerebral infarction CRP might be either a marker of cardioembolism or a predictive factor for short-term mortality.

Preliminary reports on percutaneous transluminal angioplasty (PTA) of the internal carotid artery are promising. Our experience on 32 patients with symptomatic carotid stenoses is reviewed here. Successful dilation was obtained in 33 of 35 procedures, with an estimated patency rate of 85% at 1 year. In 3 cases, transient neurologic symptoms occurred within 2 days of angioplasty. Transient neck pain and bradycardia were the most commonly observed complications during carotid dilation. Carotid PTA may be considered as a valid alternative to endarterectomy, at least in selected cases.

Magnetic resonance imaging with gadolinium DTPA is currently the most accurate method for detecting small intracanalicular yestibular schwannomas. This imaging modality is not nearly as clear in diagnosis of a small residual or recurrent neuroma after a hearing preservation procedure. This study looked for gadolinium-enhanced MRI images mimicking recurrent lesions in 104 consecutive cases of unilateral acoustic neuroma removed with a hearing preservation technique by the retrosigmoid transmeatal approach. A number of cases with enhancing MRI images in the internal anditory canal were reoperated, permitting the histologic examination of the enhancing tissue. Criteria for the MRI diagnosis of residual-recurrent acoustic neuroma are presented, along with the short-to mid-term rate of “residual-recurrent” tumor.