ABSTRACT
INTRODUCTION: Stroke recurrence is an important issue in stroke registries, but direct patient contact months after stroke is not always feasible. Telephone assessment is often used to evaluate long term stroke outcome, treatments and recurrences. Our aim is to evaluate telephone interview in a stroke registry. MATERIAL AND METHODS: Three hundred and eighty patients with a stroke or TIA were prospectively registered, evaluating baseline characteristics and type of event. At 6 months, 248 patients were reviewed by structured telephone interview and 132 were reviewed by direct contact. We analysed stroke outcome and disability, treatments and stroke or TIA recurrences. RESULTS: There were no differences in baseline characteristics and type or severity of the index event. At 6 months, treatments were similar between both groups and 10.5% (40 patients) had a recurrent event. There were no differences in recurrent ischaemic strokes (6.1% in direct contact vs 4.4% telephone, P=.49), but we detected a higher number of TIA in direct examination compared to phone interview (9.1% vs 4.0%, P=.04). CONCLUSIONS: Telephone assessment of stroke patients is reliable and facilitates stroke registries in detecting long-term treatments and stroke recurrences. However, it is probable that new transient events or TIA are under-estimated.
Subject(s)
Interviews as Topic , Ischemic Attack, Transient/diagnosis , Stroke/diagnosis , Telephone , Aftercare/methods , Aged , Aged, 80 and over , Disability Evaluation , Feasibility Studies , Female , Follow-Up Studies , Humans , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/therapy , Male , Middle Aged , Office Visits , Recovery of Function , Recurrence , Registries , Risk Factors , Severity of Illness Index , Spain/epidemiology , Stroke/epidemiology , Stroke/therapy , Treatment OutcomeABSTRACT
INTRODUCTION: Definitive diagnosis of Creutzfeldt-Jakob disease (CJD) is made by pathological study. The premortem differentiation of variant forms is important in public health. Bilateral hyperintensity of the thalamic pulvinar nucleus in T2, FLAIR and DW sequences ("pulvinar sign") in Magnetic Resonance Imaging (MRI) is related to the variant Creutzfeldt-Jakob disease (vCJD) and is a diagnostic criterion of probable vCJD. A case of sporadic CJD with bilateral hyperintensity of pulvinar nucleus is described. CASE REPORT: A case of a 64 year old male with progressive gait and cognitive functions impairment, disorientation, hallucinations, delirious, language alterations and dysphagia of 4-5 months progress is presented. Clinical examination revealed unintelligible speech, almost anartric, tetraparesis with leg predominance, bilateral Babinski sign, arms dysmetria and dysdiadochokinesia, with action myoclonias. COURSE: progressive deterioration, akinetic mutism and death in 6-7 months following the onset of symptoms. The 14-3-3 protein was positive in cerebrospinal fluid. Electroencephalogram had no periodic sharp-wave complexes. MRI: bilateral and symmetrical lesions in putamen, caudate and pulvinar nucleus, hyperintenses in T2, FLAIR and DW; bilateral hyperintensity of frontoparietal and insular cortex; the bilateral high signal in caudates and putamen is greater than the hyperintensity in pulvinar. No mutation was found in the analysis of the prionic protein (PRNP) gene. Codon 129 polymorphism: methionine/valine heterozygosis (129 M/V). The neuropathological study confirmed the diagnosis of sporadic CJD. CONCLUSIONS: Bilateral pulvinar hyperintensity can be present in sporadic CJD. A true pulvinar sign (consistent with vCJD) must be considered only if the high signal in the pulvinar is greater than the hyperintensity in the caudate and putamen nucleus.
