[The stroke patient in the doctor's office]. / Schlaganfall: Prävention--akuter Notfall--Nachsorge. Ohne Hausarzt geht da gar nichts.

The practitioner plays a key role in the primary and secondary prevention of stroke. For the treatment of an acute stroke immediate transfer to a specialized stroke unit is mandatory, while secondary prevention is oriented to the etiology of stroke. The risk factors need to be controlled more stringently than is the case for primary prevention. To ensure the appropriate organization of subsequent care, knowledge of the impairment profile and the support needed by the patient is obligatory. Apart from aiding social integration and providing medical treatment, the general physician also has the task of supporting the patient and, where necessary, treating emotional disorders. The rigorous treatment of secondary complications, or the reinstitution of rehabilitation measures to minimize functional impairments are tasks that can only be performed by the general practitioner.

[Telemedicine stroke department network. Introduction of a telemedicine pilot project for integrated stroke management in South Bavaria and analysis of its efficiency]. / Telemedizinisch vernetzte Schlaganfallstationen. Vorstellung des telemedizinischen Pilotprojekts zur integrierten Schlaganfallversorgung in Südostbayern und seiner Effizienzanalyse.

More than 100 stroke units have been established in Germany. In rural areas, however, acute stroke care needs to be improved. In order to advance clinical stroke therapy, two specialized stroke centers founded a telemedicine network (TEMPiS) among 12 community hospitals in eastern Bavaria. Each network hospital established specialized stroke wards where qualified teams manage acute stroke patients. Twenty-four hours daily, physicians in local hospitals are able to contact the stroke centers via videoconferencing including transmission of digital DICOM data. To study the efficacy of this network, a controlled trial will be performed. Five TEMPiS-network hospitals will be matched with five other hospitals equal in size, catchment area, and diagnostic techniques. For about 1 year, all consecutive stroke cases in the matched study hospitals will be prospectively recorded in a database. Neurological deficits will be quantified on the National Institute of Health Stroke Scale within 24 h after stroke onset. Mortality and institutional care as a combined primary endpoint will be assessed after 3 and 12 months. Furthermore, functional outcome according to the modified Rankin scale, Barthel score, and quality of life will be assessed using a standard telephone interview. Data acquisition started in July 2003, and final results are expected in 2005.

[Clinical presentation and prognosis of brain stem infarcts. An evaluation of the Stroke Databank of the German Stroke Foundation]. / Klinische Präsentation und Prognose von Hirnstamminfarkten. Eine Auswertung der Schlaganfall-Datenbank der Stiftung Deutsche Schlaganfall-Hilfe.

Due to the great variety of clinical classification systems and syndromes, a representative overview of the etiology and prognosis of brain stem infarctions is missing. From the German Stroke Data Bank we therefore investigated 455 patients with visible brainstem infarction on cerebral imaging in comparison to patients with other infarct localizations. Follow-up after 3 and 12 months assessed functional outcome and recurrence of cerebral ischemia. Of 455 patients with acute brainstem infarction, 115 had additional infarctions in other vascular territories. In the remaining 340 patients with isolated brainstem infarction, the classification was: small vessel disease in 36.2%, macroangiopathy in 22.6%, and cardioembolism in 11.2%. After 3 months, 10% of the patients with isolated brainstem infarction had died and 55.6% were functionally independent. Mortality was 43.5% in patients with combined brainstem infarction. Our study highlights the frequency of small vessel disease as well as the relatively favorable prognosis in isolated brainstem infarction and preserved consciousness.