[Causes of a prolonged prehospital phase in patients admitted to a stroke unit. Can it be influenced by campaigns to educate the public?]. / Ursachen einer verlängerten Prähospitalphase bei Stroke-Unit-Patienten. Beeinflussbarkeit durch Aufklärungskampagnen?

Since stroke has become a medical emergency because intravenous tissue plasminogen activator improves outcome after ischemic stroke within 3 h of symptom onset, the focus of acute stroke management lies on the prehospital phase. Having the worst median time of emergency department arrival after stroke onset according to nationwide statistics, we examined the factors influencing a late admission of 174 consecutive patients to our stroke unit and the effects of a public campaign over 5 months. The median time from symptom onset to arrival was 5.2 h; 36.4% of patients presented within 3 h at hospital. A high level of education, knowledge of the time window, direct contact with an emergency facility after stroke onset, high number of known symptoms, not living alone, and a stroke in the past were connected with an earlier presentation. The public campaign had a positive effect on median time of symptom onset to arrival from 12 h in July, 7.2 in August, 4.7 in October, 5.2 in November, and 3.2 in December 2002. This had a favorable effect on the number of thrombolysis.

[Depressed mood in the acute phase of first ischemic cerebral infarct]. / Depressive Verstimmung im Akutstadium nach erstmaligem ischämischen Hirninfarkt.

In the acute phase of cerebral ischemia, 55% of the patients showed signs of mild depression after a period of 5-9 days. The development and intensity of depressive symptoms correlated strongly with the grade of functional impairment. A statistically less significant relationship was established between the depressive symptoms and low social status, higher age, lower predisease intelligence and accompanying symptoms of anxiety. Independent of antidepressive therapy, after 4 weeks an improvement in the initially registered functional and intellectual impairment as well as the depressive symptoms (prevalence rate 23.3%) was recorded. None of these parameters correlated with each other in any way. In conclusion, we interpreted these depressive symptoms as the result of reactive coping strategies during the acute phase of cerebral ischemia. In contrast to this, the aspect of gender showed no significant relationship to the resulting depressive symptoms. Furthermore, lesion location, lesion volume, and cortical atrophy and cognitive impairment proved to have no influence on depressive symptoms. This suggests that primary organic factors are not the cause of depression in connection with the acute stroke period.