Experience with a questionnaire administered by emergency medical service for pre-hospital identification of patients with acute stroke.

We prospectively verified whether an ad-hoc questionnaire administered by phone supports pre-hospital suspicion of stroke in order to reduce the time before care is given. From June 1996 to May 1997, physicians of the Emergency Medical Service in the area of Bergamo, Italy asked all people calling for a patient with symptoms and signs suggesting a cerebral vascular injury to immediately answer some questions on common symptoms and signs of stroke. The medical records of the patients hospitalized at Ospedali Riuniti of Bergamo were reviewed at the end of the study by a single neurologist, skilled in stroke management and blinded to the questionnaires. Sensitivity and specificity, in addition to positive and negative predictive values, of single questions versus final diagnosis were assessed. Logistic regression analysis was also performed to identify those questions useful to suspect strokes. We collected 143 valid questionnaires, related to 63 men and 80 women, aged 34-99 years (mean, 71.8 years). The question concerning headache had the lowest sensitivity and specificity, respectively 57.1% and 36.5%, and the question concerning leg palsy had the highest sensitivity and specificity, respectively 82.0% and 52.4%. Multivariate analysis identified questions on facial and leg palsy as independent predictors of a final diagnosis of stroke. A few questions on motor deficits proposed by emergency medical service operators may be useful in the pre-hospital identification of stroke patients. Concordance of any questions versus final diagnosis of stroke was, however, far to be satisfying. Thus, our experience supports the need for an educational program to improve the efficiency of a pre-hospital diagnosis of stroke.

[Hyponatremia in meningeal hemorrhage]. / L'hyponatremie au cours de l'hémorragie méningée.

One hundred patients affected by S.A.H. have been studied, evaluating the possible correlations between clinical findings and hyponatremia. For a better understanding of hyponatremia during S.A.H., the hematic concentration of A.D.H. and A.N.P. have been determined and correlated with hyponatremia.

Non-medical treatment of ischemic cerebrovascular disease. Surgical operations and other methods.

Surgical operations on vessels and other methods of treatment are considered as non-medical therapies for ischemic cerebrovascular diseases. Some of these methods are accepted (improvement in lifestyle, rehabilitative measures) and some are not (acupuncture, homeopathic therapy). Considering the surgical operations, the results of microsurgical anastomoses between extra- and intracranial vessels, in particular, are discussed on the basis of experiences with 40 operated patients. The principles of some therapeutic methods like acupuncture and homeopathic therapy are then presented.

Microsurgical technique in the treatment of vascular compression of cranial nerves in the posterior fossa.

The authors report on 2 cases: cerebello-pontine syndrome and a trigeminal neuralgia with homolateral facial spasm. In both patients the clinical syndrome was thought to be of vascular origin and the vessels accompanying the nerves showed to be tightly anchored to them by means of arachnoid bridges. Microsurgery allowed for performing section of the arachnoid bridges in order to prevent the nerves from the continuous microtrauma due to the vascular pulsation, this being the pathogenic mechanism responsible for the suffering of the nerves themselves.

Critical evaluation of commissural myelotomy in the treatment of intractable pain.

The Authors describe 6 cases of commissural myelotomy performed on patients suffering from malignant neoplasms at the Neurosurgical Department of Bergamo. A review of all cases reported in the literature has been documented by clinical data supported by anatomophysiological considerations.