[Case fatality after acute stroke at the Reykjavik Hospital in 1996-1997.].

OBJECTIVE: The purpose of this study was to describe case-fatality after acute stroke at the Reykjavik Hospital. A study describing the outcome of stroke patients in an Icelandic population has not been published before. MATERIAL AND METHODS: A prospective hospital-based stroke registry has been conducted at the Reykjavik Hospital since January 1996. Patients with ischemic stroke and intracerebral hemorrhage were included in this study but patients with transient ischemic attack (TIA), subarachnoid hemorrhage and hemorrhage due to hereditary cystatin C amyloid angiopathy were excluded. We describe the severity of symptoms at stroke onset, length of hospital stay and outcome. RESULTS: In 1996 and 1997 a total of 377 events were registered. Ischemic stroke was diagnosed in 88% and hemorrhagic stroke in 12%. The case-fatality was 17%, 71% of the patients were discharged home and 12% to nursing care. The average length of hospital stay was 28.7 days (95% CI 24.1-33.3) and 63% of patients were treated at the stroke unit. Eighty-five percent of patients could have been treated at the stroke unit but 15% needed intensive care unit (ICU) or other intensive medical care. CONCLUSIONS: Case-fatality was lower and the pro-portion of patients discharged home was higher than we have seen reported in foreign studies. Stroke may be a less severe disease in Iceland than in other Western countries.

[Migraine-related stroke. Two case-reports.].

Migraine is the cause of 3-25% of strokes in young adults. Each year we can expect 9-10 cases of migraine-related stroke in Iceland. The most common symptom is hemianopia but other common symptoms include hemiparesis, hemianesthesia, dysphasia and various brain stem symptoms. The stroke must occur during a typical migraine attack and other causes have to be excluded. Here we describe two cases of migraine-related stroke.

[Etiology and treatment of cerebral ischemia at the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital.].

OBJECTIVES: This is the first Icelandic study in which the etiology of cerebral ischemia is examined. The goal of the study was to examine how the etiology of cerebral infarcts and transient ischemic attacks was determined at the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital and how the patients were treated. MATERIAL AND METHODS: The study was retrospective and included 102 patients with cerebral infarcts and transient ischemic attacks that were admitted to the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital in 1994. Patients with cerebral hemorrhage were excluded. The patients' mean age was 68.5 years (range 25-89) and the male:female ratio was 59:43. Cerebral computerized tomography was obtained from 98 (98%) patients. Carotid ultrasonography was done in 72 (72%) cases and carotid angiogram in 14 (14%) patients. Transthoracic echocardiography was done in 69 (69%) cases and transesophagal echocardiography in the 11 (11%) youngest patients. RESULTS: Of the 102 patients, 79 (79%) had cerebral infarctions and 23 (23%) transient ischemic attacks. The probable cause of cerebral infarction was cardioembolic in 21 patients (27%), lacunar infarction in 16 patients (20%) and carotid artery disease in 13 patients (16%). In 37% of the cases the cause was unspecific. The etiology of transient ischemic attacks was carotid artery disease in four patients (17%), cardioembolic in two patients (9%) and lacunar in one patient (4%). In 70% of the cases the cause of transient ischemic attacks was undetermined. Nine of the 102 patients (9%) underwent carotid endarterectomy and 15 (15%) were treated with warfarin. CONCLUSION: A specific etiology was found in 2/3 of those with cerebral infarcts and in 1/3 of those with transient ischemic attacks. Determination of etiology led to specific preventive treatment in 1/4 of the patients.

The penetration of metrizamide into the brain after routine lumbar myelography as shown by cerebral computed tomography and its effect on auditory brainstem transmission time.

Metrizamide is a widely used contrast medium with some well known adverse reactions. In a preliminary study, CT scans and brain stem evoked potentials (BAEP) were done before and 18 hours following lumbar myelography on 12 patients. A statistically significant prolongation of the BAEP was observed. Metrizamide therefore seems to be a potent substance in clinical use as indicated by its effect on BAEP. BAEP should not be done within the first few days after myelography with metrizamide.

Prognostic significance of cerebral computed tomography results in supratentorial infarction.

In 69 patients with supratentorial cerebral infarction findings at computed tomography (CT) were related to clinical state on admission and course of recovery. In patients with initial disability of slight to moderate degree CT did not provide prognostically useful information; in patients with severe symptoms at onset location of lesion to the internal capsule or the right parietal lobe and the presence of the mass effect, as single factors or in combination, were ominous CT indicators in terms of functional recovery.

Confusion, myoclonus and speech arrest: epileptic manifestations after metrizamide myelography.

The importance of accurate diagnosis of epileptic manifestations, even if unusual, as complications of diagnostic metrizamide exploration of the CSF space is emphasized on the basis of 2 case histories.

Computed tomography and subarachnoid hemorrhage.

CT scans have been made on 39 of 41 patients who presented with subarachnoid hemorrhage. Blood could be visualized in the cisterns of 18 of 32 examinations performed within five days of the hemorrhage all having aneurysms. Among the other 14 there were three in whom no aneurysm was found on angiography. The distribution of blood in those that showed it was useful in pointing to the position of the aneurysm. Much other information was obtained, for instance about rebleeding and infarction. CT should routinely be the primary examination, followed by selective angiography.