The use of an online Epworth Sleepiness Scale to assess excessive daytime sleepiness.

PURPOSE: Excessive daytime sleepiness is the most common complaint reported in sleep clinics. We hypothesised that utilising modern media to deliver an online Epworth Sleepiness Scale, age- and gender-related differences in subjective daytime sleepiness could be assessed. METHODS: Age, gender and online Epworth Sleepiness Scale (range 0-24 points) of 39,448 subjects were recorded between January 2013 and November 2015. RESULTS: A significant trend, for males but not females, was found between age and Epworth score (p < 0.001). Average scores were higher for female subjects in their 1st and 2nd (p = 0.014), 3rd (p < 0.011) and 4th lifetime decade (p = 0.011), whereas male subjects conveyed significantly higher levels of sleepiness in their 7th lifetime decade (p < 0.001). Individual item analysis found differences between gender; females scored significantly higher than males in items 1, 4 and 5, while male subjects had higher scores for items 3, 6, 7 and 8. Lowest levels of sleepiness were reported for item 8 and highest scores for item 5. CONCLUSIONS: The use of an online Epworth Sleepiness Scale identifies gender- and age-specific differences and facilitates new pathways in the delivery of chronic care.

Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis.

Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn's disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients.