[Stroke. Public knowledge and information sources]. / Schlaganfall. Wissen und Informationsquellen in der Bevölkerung.

Modern stroke care requires urgent initiation of treatment. Thus, rapid recognition of cerebrovascular incidents by medical laypersons is mandatory. Accordingly, public knowledge of stroke warning signs and adequate action is very important. Little is known about the level of knowledge among the general public and use and effect of various sources of information. In first aid training programs conducted by the St. John Ambulance in Bavaria, participants were questioned if and from what source they already got information about stroke. Additionally they were asked to list stroke warning signs and to describe what a stroke is. Altogether 532 subjects filled out the questionnaire; 419 stated that they already had heard something about stroke (53.7% male, mean age 29.4 years). Sources of information were: personal experience with affected patients (30.1%), TV/radio (22.1%), newspaper (18.4%) and relatives/friends (17.2%). Subjects with prior information listed significantly more warning signs/symptoms compared with those without previous information (1.76 vs. 0.63; p<0.01). Participants using the source "TV/radio" named fewer warning signs than those using the sources "newspaper" or "affected patients" (p<0.01). Prior information was effective in enhancing knowledge about stroke. However, we found significant differences related to the source of information. Since experiences gathered from personal contact with affected patients were stated most frequently, leading to better knowledge than information gained from mass media, subsequently acute care and rehabilitation would be a good opportunity for providing information about stroke to proxies and visitors of the patients.

[Multimodal computed tomography in acute cerebral infarction. Experience with a standardized protocol in 100 patients]. / Multimodale Computertomographie beim akuten Hirninfarkt. Erfahrungen mit einem standardisierten Untersuchungsprotokoll bei 100 Patienten.

Computed tomography (CT) is the standard method of brain imaging in acute stroke. To an experienced examiner, nonenhanced CT will exclude hemorrhage and may indicate early ischemic signs. Reliable description of an ischemic area and the underlying vascular disease is not possible in the acute phase but is possible, particularly within the first hours, when therapeutic decisions on matters such as systemic thrombolysis are to be made. For such rapid decision-making, imaging must provide more information. Novel, contrast-enhanced CT techniques can provide this information. Perfusion CT (CTP) can show brain perfusion, allowing one to distinguish between reversible and irreversible damage in an ischemic area. Also, CT angiography (CTA) can detect occlusion or stenosis in the relevant vasculature. Using a modern, multislice CT scanner, it is now possible to combine these modalities of imaging. In a fast protocol for emergency evaluation, all three methods can be performed and evaluated to provide the crucial information within 15 min. In the first 102 patients examined within 6 h of symptom onset using this protocol, multimodal CT contributed substantially to therapeutic decisions, even though there are some limitations in these methods.

[Hospitalization of non-stroke patients in a Stroke Unit]. / Einweisung von Nicht-Schlaganfallpatienten auf eine Stroke Unit.

BACKGROUND AND OBJECTIVE: Stroke care in Germany has substantially improved during the last decade. One column of modern stroke care is the institution of stroke unit which allows rapid diagnosis and treatment. The aspect of admission of nonstroke patients to a stroke unit is poorly evaluated. The aim of this study is to evaluate the number of patients who are admitted to a national stroke unit but do not suffer from stroke. Furthermore, we related the proportion of nonstroke referrals to the different referral modes. PATIENT AND METHODS: Observational study recording all suspected stroke referrals with regard to final diagnosis and type of referral during a 12-month period (1.8.2002-31.7.2003). RESULTS: 462 patients were admitted by 4 routes: 74 by paramedics or by self-presentation, 138 by emergency physicians, 144 by primary care doctors, and 106 were transferred from other hospitals. 88 patients (19 %) finally revealed no acute stroke. The most common nonstroke diagnoses were seizure (20 %), dissociative disorders (14 %), cranial nerve disorders (11 %), hypoglycaemia (8 %) and transient global amnesia (7 %). There was no significant difference among the proportion of nonstroke patients referred by ambulance paramedics and self-presentation (15 %), emergency physicians (21 %), primary care doctors (15 %) and interhospital transfer (24 %) [p = 0.222, X (2)-test according to Pearson]. CONCLUSION: Due to the fact that a number of clinical neurological conditions mimic acute stroke, misdiagnosis of stroke is common. We advocate that all stroke patients are seen early in the course of the disease by a neurologist. An alternative could be that in stroke units of internal medicine hospitals patients are seen by a consulting neurologist. Alternatively, telemedicine might be used and the neurologist on duty of a neurological stroke unit could be consulted.

Upregulation of CD40-CD40 ligand (CD154) in patients with acute cerebral ischemia.

BACKGROUND AND PURPOSE: Inflammation and hypercoagulability contribute to the development of acute cerebral ischemia. Both can be mediated by the CD40 system. This study investigated whether the CD40 system and related mediators are upregulated in patients with transient ischemic attack (TIA) or stroke. METHODS: Seventeen patients with TIA, 60 patients with complete stroke, and 15 control subjects were investigated. CD154 and P-selectin were analyzed on platelets and CD40 on monocytes during and 3 months after acute cerebral ischemia by double-label flow cytometry. Blood concentrations of soluble CD154 and monocyte chemoattractant protein-1 (MCP-1) were evaluated. RESULTS: Our main findings are as follows: (1) patients with acute cerebral ischemia showed a significant increase of CD154 on platelets and CD40 on monocytes compared with controls; (2) plasma levels of soluble CD154 were significantly higher in these patients; (3) these patients had significantly higher numbers of prothrombotic platelet-monocyte aggregates; (4) the chemoattractant MCP-1 was significantly elevated in cerebral ischemia; and (5) at 3 months' follow-up, upregulation of CD154 still persisted in patients with previous acute cerebral ischemia. CONCLUSIONS: Patients with acute cerebral ischemia show upregulation of the CD40 system, which might contribute to the known proinflammatory, proatherogenic, and prothrombotic milieu found in these patients.

Acute stroke management in the local general hospital.

BACKGROUND AND PURPOSE: The majority of stroke patients are treated in local general hospitals. Despite this fact, little is known about stroke care in these institutions. We sought to investigate the status quo of acute stroke management in nonspecialized facilities with limited equipment and resources. METHODS: Four general hospitals located in smaller cities of a rural area in Germany participated in this study. The 4 hospitals were similar in structure and technical equipment; none had a CT scanner in-house. We reviewed the medical records of every stroke patient hospitalized in 1 of the 4 hospitals within a period of 8 weeks within 1 year. RESULTS: We collected data of a total of 95 patients at all 4 hospitals. The frequency of diagnostic tests was low: at least 1 CT scan was obtained in only 36.8% of all cases, whereas diagnostic methods available in-house were used more frequently, such as Doppler ultrasound (49.0%), echocardiography (42.3%), and 24-hour ECG registration (48.4%). Each hospital had a different therapeutic approach. Main therapeutic options were the use of pentoxyfilline (0% to 90.5%), osmodiuretics (0% to 90%), piracetam (0% to 93.3%), and hydroxyethylstarch (4.8% to 30%). Medication for long-term secondary prevention was given to 69.8% of all patients. CONCLUSIONS: This study provides one of the few data samples reflecting stroke care in smaller general hospitals. The findings demonstrate a partially suboptimal level of care in these institutions. To achieve future improvements, extended human and technical resources as well as research for stroke care should not be restricted to academic stroke centers.

Cognitive procedural learning in amnesia.

This group study examined the role of residual declarative memory and task-specific cognitive abilities for cognitive procedural learning in amnesia. 20 amnesic patients and 40 control subjects were studied, using four new cognitive tasks, as well as the Tower of Hanoi and a Mirror Reading task. On the cognitive tasks, but not on Mirror Reading, the learning of amnesic patients was significantly impaired relative to controls. Between- and within-group differences in learning were found to be statistically related to cognitive abilities that are involved in the processing of the procedural tasks. In amnesic patients, significant effects of residual declarative memory on learning scores were not observed, but there was indirect evidence for a role of memory in two tasks. The analysis of the correlative relationship between absolute procedural task performances and cognitive abilities indicated a prolonged dependence on nonspecific intellectual abilities in amnesic patients, suggesting a retarded transition to more advanced stages of skill acquisition.