Effectiveness of public stroke educational interventions: a review.

BACKGROUND AND PURPOSE: Recognizing stroke symptoms and acting quickly can reduce death and disability, but public awareness of stroke risk factors, symptoms and what to do about them is still limited. Stroke educational campaigns are used worldwide but there are few published evaluations of such campaigns. METHODS: The literature from 1999 to 2012 on the effectiveness of stroke educational campaigns was reviewed and summarized with narrative synthesis. Web-based campaigns were also described. Three databases and one search engine were explored with two keywords (stroke campaign and stroke promotion). The reference lists of all included articles were also examined. RESULTS: Twenty-two intervention studies and five web-based campaigns were included in the review. Most interventions proved partially effective, in terms of gender preference (women) or type of information retained or media preferred. Only one intervention proved ineffective. Mass media campaigns can be effective but require sustained funding, and their ability to target high-risk subgroups, whether aging, linguistic or socioeconomic, is unclear. Three community-based participatory stroke promotion interventions proved partially effective, but the small sample sizes might have underpowered the results. Web-based campaigns are efficient in reaching a large number of people but tend to attract a selected and self-selected population. CONCLUSIONS: Stroke educational campaigns have the potential to improve knowledge and awareness and change the behavior of a large number of people. Health promoters and investigators must adopt flexibility and participatory mentality to develop cost-effective interventions. Both community-based campaigns and E-tools should be integrated within a comprehensive multifaceted stroke promotion strategy to expand their reach.

When a pregnancy required a neurological consultation: a case report.

Posterior reversible encephalopathy syndrome (PRES) is a transient clinical and neuroradiological syndrome characterized by clinical signs and symptoms including hypertension, seizures, altered mental status, headache, and vision changes and characteristic features on head computed tomography (CT) or magnetic resonance imaging (MRI) scan. PRES is most commonly reported in the literature in association with obstetric patients suffering from pre-eclampsia or eclampsia. In the acute setting, it is important to recognize the characteristics of PRES and immediately treat patients' emerging conditions that are hypertension and seizures. The following case report describes a pregnant patient who presented clinical characteristics of eclampsia with recurrent episodes of seizure and hypertension complicated by PRES. This case highlights the importance of early recognition and treatment of this condition that is usually transient and completely reversible, but can lead to ischemic injury and irreversible brain damage.

Recurrent episodes of syncope in a patient with cerebral arteriovenous malformation.

As there are a number of possible causes of syncope, differentiation between cardiovascular disease, neurogenic disease and other disorders is mandatory. Cerebral arteriovenous malformations (AVMs) are tangled anastomoses of blood vessels of varying calibre in which arteriovenous shunting occurs in a central nidus, which is the area towards which multiple feeding arteries converge and from which enlarged veins drain. We describe a clinical case of syncope caused by a large AVM discovered in a 66-year-old woman. The symptoms were probably related to an epileptogenic mechanism since the syncope disappeared following the administration of antiepileptic therapy. The anatomical, pathological and clinical aspects of AVMs are discussed.

Chlamydia pneumoniae infection in young stroke patients: a case--control study.

Retrospective and cross-sectional studies have suggested that both bacterial and viral infections may be risk factors for atherosclerosis, ischemic stroke and acute coronary events. The correlation between Chlamydia pneumoniae and atherosclerosis remains a source of controversy. Our case-control study is aimed at evaluating the frequency of C. pneumoniae infection in a cohort of young adults with recent cerebrovascular disease and in particular etiologic stroke subtypes. Chlamydia pneumoniae IgG, IgM and IgA antibodies were evaluated by microimmunofluorescence method and antibody titers to both recombinant antigens chlamydial outer protein 2 and 60-kDa chlamydial heat shock protein (HSP60) by ELISA. The two groups differed with regard to the prevalence of C. pneumoniae IgA (P < 0.001) and IgG (P < 0.0001), as well as the titer of anti-R-HSP60 IgG (P < 0.001). We found an increase in IgA titers, suggestive of persistent, chronic active infection, in 16 patients in whom the etiology of the cerebral ischemic event was large-vessel atherothrombosis. Persistent, active C. pneumoniae infection may be an additional risk factor for ischemic stroke mainly of atherotrombotic origin in young subjects. However, a large-scale prospective confirmation of our findings is required.