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‘Urinary incontinence after stroke’ explores the problem of urinary incontinence. It describes the different types of urinary incontinence with a focus on the types of incontinence prevalent after a stroke; the impact of this symptom complex on the psychological state of the patient, mortality, dependency, and institutionalization; the age related changes in the urinary tract; the epidemiology of post-stroke urinary incontinence, risk factors predisposing to it, assessment methods (including bedside assessments), management with identification of transient causes of incontinence, behavioural strategies, pharmacological therapy, treatment of comorbid conditions, and management in special situations. Urge incontinence, stress incontinence, incomplete emptying, functional incontinence, overflow incontinence, and lower urinary tract symptoms, are all discussed in the context of the pathophysiology and management of these conditions.

‘Readmission to hospital after stroke’ explores the important area of hospital readmissions after a stroke. The authors examine the importance of hospital readmissions, the worldwide data, the influence of healthcare on readmissions, the current evidence and limitations of the available data, and the reasons for readmissions. The authors also discuss some illustrative case vignettes, how to identify patients at risk of readmissions, predicting risk of readmissions, strategies for prevention, implications for patients and healthcare workers, and the implications of stroke readmissions for health services and healthcare providers. There is a significant resource implication and consequent economic burden from stroke hospitalization, especially if this becomes a recurrent issue. While there is no doubt that readmissions are necessary in a cohort of patients who require urgent and specialized hospital care, a significant proportion of readmissions of stroke survivors may be preventable.

Progressive neurological signs and symptoms, in immunocompromised individuals, could be due to progressive multifocal leukoencephalopathy (PML). We report the case of a patient who present a stroke unit with symptoms that were consistent initially with a posterior circulation stroke. Prior chemotherapy with Rituximab, for a lymphoma, had predisposed the patient to infection with the JC virus. Physicians need to be aware of the condition, and patients need to aware of these risks of chemotherapy.

Cardiovascular disease including stroke is a major complication that tremendously increases the morbidity and mortality in patients with diabetes mellitus (DM). DM poses about four times higher risk for stroke. Cardiometabolic risk factors including obesity, hypertension, and dyslipidaemia often co-exist in patients with DM that add on to stroke risk. Because of the strong association between DM and other stroke risk factors, physicians and diabetologists managing patients should have thorough understanding of these risk factors and management. This review is an evidence-based approach to the epidemiological aspects, pathophysiology, diagnostic work up and management algorithms for patients with diabetes and stroke.

Response: We appreciate the interest of Dr Kahn and colleagues1 in our recent publication on hospital-level variation in mortality and rehospitalization after acute ischemic stroke among Medicare patients.2 The authors call attention to potential differences in mortality and rehospitalization rates for patients with acute ischemic stroke in the United States compared with the United Kingdom and other countries outside the United States. It is important to note that our study reported outcomes only for fee-for-service Medicare patients aged ≥65 years who were hospitalized with acute ischemic stroke. Because age is a major risk factor for both death and rehospitalization after ischemic stroke, the event rates from our study cannot be reliably compared with other studies that include patients with …

Introduction Cerebral misery perfusion represents a failure of cerebral autoregulation. It is an important differential diagnosis in post-stroke patients presenting with collapses in the presence of haemodynamically significant cerebrovascular stenosis. This is particularly the case when cortical or internal watershed infarcts are present. When this condition occurs, further investigation should be done immediately. Case presentation A 50-year-old Caucasian man presented with a stroke secondary to complete occlusion of his left internal carotid artery. He went on to suffer recurrent seizures. Neuroimaging demonstrated numerous new watershed-territory cerebral infarcts. No source of arterial thromboembolism was demonstrable. Hypercapnic blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging was used to measure his cerebrovascular reserve capacity. The findings were suggestive of cerebral misery perfusion. Conclusions Blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging allows the inference of cerebral misery perfusion. This procedure is cheaper and more readily available than positron emission tomography imaging, which is the current gold standard diagnostic test. The most evaluated treatment for cerebral misery perfusion is extracranial-intracranial bypass. Although previous trials of this have been unfavourable, the results of new studies involving extracranial-intracranial bypass in high-risk patients identified during cerebral perfusion imaging are awaited. Cerebral misery perfusion is an important and under-recognized condition in which emerging imaging and treatment modalities present the possibility of practical and evidence-based management in the near future. Physicians should thus be aware of this disorder and of recent developments in diagnostic tests that allow its detection.

Inclusion body myositis (IBM), a condition characterised by progressive muscle weakness and inclusion bodies visible on muscle biopsy, is the most common type of myopathy in patients over 50 years of age. However, it is not only under diagnosed but frequently misdiagnosed as polymyositis and hence wrongly treated with steroids. In the evaluation of progressive weakness in older Caucasian males, IBM should be an important diagnostic consideration. Treatment-resistant 'polymyositis' in patients over 50 years of age is often IBM. If there is no histological confirmation, the diagnostic criteria allow for a category of 'possible IBM'. Sometimes, the diagnosis is missed because of the slow progression of the disease and a lack of suspicion on the part of physicians. The following case report and literature review will explore many of these issues.