Determinants of early outcome in spontaneous lobar cerebral hemorrhage.

OBJECTIVE: To identify determinants of early outcome in spontaneous lobar hemorrhage. MATERIALS AND METHODS: From 2500 acute stroke patients included in a prospective hospital-based stroke registry over a 12-year period, 97 cases of lobar hematoma were selected. Determinants of in-hospital mortality were studied in multiple regression models. RESULTS: Lobar hematomas accounted for 3.9% of all acute stroke patients and 35.9% of intracerebral hemorrhages. The presence of chronic obstructive pulmonary disease (COPD) was a significant predictive variable in the model based on demographic variables and vascular risk factors [odds ratio (OR): 17.18; 95% CI: 1.77-166.22] and in the model based on these variables plus clinical data (OR: 15.12; 95% CI: 1.27-179.59). Other predictive variables included altered consciousness, previous cerebral infarct and chronic liver disease. CONCLUSIONS: COPD appeared as the most important predictor of death during hospitalization after lobar cerebral hemorrhage, a finding not generally acknowledged earlier.

Lacunar stroke in patients with intermittent claudication.

OBJECTIVES: To compare the characteristics of lacunar stroke (LS) in patients with and without intermittent claudication. MATERIAL AND METHODS: Data of 484 consecutive patients with LS were collected from a prospective hospital-based stroke registry in which 2500 patients are included. RESULTS: Of the 142 patients with ischemic stroke and intermittent claudication, 39 (27.5%) had LS (8% of all lacunes). In the multivariate analysis, small centrum ovale topography (odds ratio 7.35), carotid stenosis >50% (odds ratio 3.17), and absence of limitation at discharge (odds ratio 2.01) were independent variables significantly associated with LS in patients with intermittent claudication. CONCLUSION: Only 8% of patients with LS had intermittent claudication. The short-term prognosis is good with a spontaneous early neurological recovery at discharge in 51.3% of patients. LS patients with intermittent claudication showed a striking similarity in risk factors and clinical syndromes in comparison with the LS patients without intermittent claudication.

Relevance of transient ischemic attack to early neurological recovery after nonlacunar ischemic stroke.

BACKGROUND: We hypothesized that previous transient ischemic attack (TIA) had a favorable effect on early outcome after acute nonlacunar ischemic stroke. METHODS: Data of 1,753 consecutive patients with ischemic stroke collected from a prospective hospital-based stroke registry were studied. A comparison was made of the groups with and without previous TIA. Favorable outcome included spontaneous neurological recovery or grades 0-2 of the modified Rankin scale at hospital discharge. RESULTS: Previous TIA occurred in 55 (11.5%) of 484 patients with lacunar stroke and in 166 (13.1%) of 1,269 patients with nonlacunar stroke. The percentage of nonlacunar ischemic stroke patients with favorable outcome was 21.7% in those with a history of TIA compared to 15% without TIA (p < 0.03). In the lacunar stroke group, differences were not significant. In the multivariate analysis, TIA was an independent predictor of spontaneous in-hospital recovery. CONCLUSIONS: Prior TIA was associated with a favorable outcome in nonlacunar ischemic stroke, suggesting a neuroprotective effect of TIA possibly by inducing a phenomenon of ischemic tolerance allowing better recovery from a subsequent ischemic stroke.

Clinical study of 35 patients with dysarthria-clumsy hand syndrome.

OBJECTIVES: Although dysarthria-clumsy hand syndrome (DCHS) is a well known and infrequent lacunar syndrome, there are few data regarding the spectrum of associated clinical characteristics, anatomical site of lesion, and aetiopathogenetic mechanisms. We report a clinical description of this subtype of lacunar stroke based on data collected from a prospective acute stroke registry. METHODS: From 2500 acute stroke patients included in a hospital based prospective stroke registry over a 12-year period, 35 patients were identified as having DCHS. RESULTS: DCHS accounted for 1.6% of all acute stroke patients (35/2110), 1.9% of acute ischaemic stroke (35/1840), and 6.1% of lacunar syndromes (35/570) admitted consecutively to a neurology department and included in the stroke registry over this period. The results supported the lacunar hypothesis in 94.3% of patients (n = 33). Atherothrombotic and cardioembolic infarction occurred in only one patient each (2.9%). No patient with DCHS had an intracerebral haemorrhage. Outcome was good (mortality in hospital 0%, symptom free at discharge 45.7%). After multivariate analysis, absence of limitation at discharge, limb weakness but not cerebellar-type ataxia, and internal capsule (40%), pons (17%), and corona radiata (8.6%) location were significantly associated with DCHS. CONCLUSIONS: DCHS is a rare cerebrovascular syndrome, and supports the criteria of the lacunar hypothesis. The majority of patients in this study had internal capsule infarcts. The prognosis is good with striking similarity compared with other types of lacunar strokes. There are important differences between DCHS and non-lacunar strokes. Internal capsule and pons are the most frequent cerebral sites.

Migrainous cerebral infarction in the Sagrat Cor Hospital of Barcelona stroke registry.

Nine of 2000 consecutive stroke patients included in the Sagrat Cor Hospital of Barcelona Stroke Registry over a 10-year period fulfilled the strictly defined International Headache Society criteria for migrainous stroke and in whom other causes of stroke were ruled out. They accounted for 13% of all first-ever ischaemic stroke of unusual cause. Migrainous stroke was more common in women (67%) and in patients aged 45 years or younger (78%) compared to the remaining ischaemic strokes of unusual cause. No patient died during hospital stay and 67% were symptom-free at discharge. In the multivariate analysis, nausea or vomiting (odds ratio (OR) 8.40, 95% confidence interval (CI) 1.49-47.21) and age (OR 0.95, 95% CI 0.91-0.99) were predictors of migrainous stroke. Migrainous stroke is a rare entity. Vascular risk factors are uncommon and the prognosis is generally good. Patients with migrainous stroke present some different clinical features from other ischaemic strokes of unusual aetiology.

Site of bleeding and early outcome in primary intracerebral hemorrhage.

OBJECTIVES: To describe the influence of the site of the bleeding on clinical spectrum and early outcome of patients with acute spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS: ICH was diagnosed in 229 (11%) of 2000 consecutive stroke patients included in a prospective stroke registry over a 10-year period. Frequency of demographic variables, risk factors, clinical events, neuroimaging data, and early outcome (until hospital discharge) according to different sites of bleeding was assessed. Each topography of the bleeding (independent variable) was compared with the remaining ICH cases by means of logistic regression analysis. RESULTS: In the multivariate analysis, sensory deficit was significantly associated with ICH in the thalamus; lacunar syndrome and hypertension with ICH in the internal capsule-basal ganglia; seizures, non-sudden stroke onset, and hypertension with lobar ICH; ataxia and sensory deficit with ICH in the cerebellum; cranial nerve palsy with ICH in the brainstem; and limb weakness, diabetes, and altered consciousness with multiple topographic involvement. The overall in-hospital mortality rate was 31%, but this varied from 65% for multiple topographic involvement, 44% for intraventricular ICH, and 40% for ICH in the brainstem to 16% for ICH in the internal capsule-basal ganglia. CONCLUSION: These data show the heterogeneous clinical profile of ICH, but they also suggest a difference in the clinical spectrum and in-hospital mortality according to the site of bleeding.

Clinical study of 222 patients with pure motor stroke.

The objective was to assess the frequency of pure motor stroke caused by different stroke subtypes and to compare demographic, clinical, neuroimaging, and outcome data of pure motor stroke with those of patients with other lacunar stroke as well as with those of patients with non-lacunar stroke. Data from 2000 patients with acute stroke (n=1761) or transient ischaemic attack (n=239) admitted consecutively to the department of neurology of an acute care 350 bed teaching hospital were prospectively collected in the Sagrat Cor Hospital of Barcelona stroke registry over a 10 year period. For the purpose of the study 222 (12.7%) patients with pure motor stroke were selected. The other study groups included 218 (12.3%) patients with other lacunar strokes and 1321 (75%) patients with non-lacunar stroke. In relation to stroke subtype, lacunar infarcts were found in 189 (85%) patients, whereas ischaemic lacunar syndromes not due to lacunar infarcts occurred in 23 (10.4%) patients (atherothrombotic stroke in 12, cardioembolic stroke in seven, infarction of undetermined origin in three, and infarction of unusual aetiology in one) and haemorrhagic lacunar syndromes in 10 (4.5%). Patients with pure motor stroke showed a better outcome than patients with non-lacunar stroke with a significantly lower number of complications and in hospital mortality rate, shorter duration of hospital stay, and a higher number of symptom free patients at hospital discharge. After multivariate analysis, hypertension, diabetes, obesity, hyperlipidaemia, non-sudden stroke onset, internal capsule involvement, and pons topography seemed to be independent factors of pure motor stroke in patients with acute stroke. In conclusion, about one of every 10 patients with acute stroke had a pure motor stroke. Pure motor stroke was caused by a lacunar infarct in 85% of patients and by other stroke subtypes in 15%. Several clinical features are more frequent in patients with pure motor stroke than in patients with non-lacunar stroke.

Ischemic stroke of unusual cause: clinical features, etiology and outcome.

The clinical features, etiology and neurological outcome of ischemic stroke of unusual cause (ISUC) have rarely been reported. We retrospective reviewed all patients with this stroke subtype entered in the Sagrat Cor Hospital of Barcelona Stroke Registry, which includes data from 2000 consecutive first-ever stroke patients admitted to the hospital between 1986 and 1995. Patients with previous ischemia and/or hemorrhagic stroke were excluded. Topographic, anamnestic, clinical and neuroimaging characteristics of ISUC were assessed. Predictors of this stroke subtype were determined by logistic regression analysis. Ischemic stroke of unusual etiology was diagnosed in 70 patients (32 men and 38 women), with a mean +/- SD age of 52 +/- 22.4 years. This stroke subtype accounted for 4.3% of all first-ever strokes and 6% of all first-ever brain infarcts. Etiologies included hematological disorders in 17 cases, infection in 11, migraine stroke in 10, cerebral infarction secondary to venous thrombosis in nine, primary inflammatory vascular conditions in six and miscellaneous causes in 17. In the multivariate analysis after excluding cerebral venous thrombosis (n = 9) and arterial dissection (n = 4), because of typical clinical and radiological features, independent predictors of ISUC included 45 years of age or less (odds ratio [OR] 14.8), seizures (OR 6.8), headache (OR 5.2), hemianopia (OR 2.6) and occipital lobe involvement (OR 3.0). Patients with ISUC presented a lower in-hospital mortality rate (7.1% vs. 14.4%; P < 0.05), were more frequently symptom free at discharge (35.7% vs. 25.80%; P < 0.05) and experienced a longer mean length of hospital stay (23.7 days vs. 18.2 days; P = 0.06) than non-ISUC patients. We conclude that ISUC is infrequent, etiologies are numerous and hematologic disorders are the most frequent cause. We emphasize the better prognosis and the need to distinguish it from other ischemic stroke subtypes which have a different treatment approach and outcome.

Acute cerebrovascular disease in women.

In 2,000 consecutive stroke patients collected in a prospective hospital-based stroke registry over a 10-year period, we assessed whether stroke in men and women was different in respect to vascular risk factors, clinical features and natural history. The frequency of the different variable in men and women was analyzed by means of univariate analysis and logistic regression models. Women accounted for 48% of the study population (n = 967) and were older than men (mean age 75 vs. 69 years, p < 0.001). In the age group of 85 years or older, stroke was more frequent in women than in men (69.8 vs. 30.2%, p < 0.001). Women showed a higher frequency of cardioembolic infarction and a lower occurrence of lacunar infarction and stroke of undetermined cause than men. In-hospital mortality (17.4 vs. 13.3%) and length of hospital stay (19.6 vs. 16.7 days) was significantly higher (p < 0.001) in women than in men. In the model based on demographic variables and cardiovascular risk factors, obesity, heart failure, atrial fibrillation and age were significant predictors of stroke in women, while intermittent claudication, ischemic heart disease, chronic obstructive pulmonary disease, cigarette smoking and alcohol abuse were predictors in male sex. Hypertension and limb weakness were predictors for stroke in women, and absence of neurological deficit at hospital discharge, lacunar syndrome and ataxia were predictors in men in the models based on all variables. Women differ from men in the distribution of risk factors and stroke subtype, stroke severity and outcome. Differences in stroke pathology and/or differences in functional anatomy or plasticity of the brain between sexes may account for these findings.

Different vascular risk factor profiles in ischemic stroke subtypes: a study from the "Sagrat Cor Hospital of Barcelona Stroke Registry".

OBJECTIVES: To characterize the vascular risk factor profiles in different subtypes of ischemic stroke. MATERIAL AND METHODS: The study population consisted of 1473 consecutive ischemic stroke patients collected in a prospective stroke registry. The prevalence of vascular risk factors in each stroke subtype was analyzed independently and in comparison with other subtypes of stroke pooled together by means of univariate analysis and logistic regression models. RESULTS: Hypertension was present in 52% of patients followed by atrial fibrillation in 27% and diabetes in 20%. The pattern of risk factors associated with atherothrombotic stroke included chronic obstructive pulmonary disease (COPD) (odds ratio [OR] = 2.63), hypertension (OR = 2.55), diabetes (OR = 2.26), transient ischemic attack (OR = 1.61), and age (OR = 1.03). Previous cerebral hemorrhage (OR = 4.72), hypertension (OR = 4.29), obesity (OR = 2.45), and diabetes (OR = 1.73) were strong predictors of lacunar stroke. In the case of cardioembolic stroke, atrial fibrillation (OR = 22.24), valvular heart disease (OR = 10.97), and female gender (OR = 1.66) occurred more frequently among patients with this stroke subtype than among the other stroke subtypes combined. CONCLUSION: Different potentially modifiable vascular risk factor profiles were identified for each subtype of ischemic stroke, particularly COPD in the case of atherothrombotic stroke and previous cerebral hemorrhage and hypertension in the case of lacunar infarction.

Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage.

OBJECTIVE: We tested the hypothesis that diabetes is an independent determinant of outcome after intracerebral hemorrhage (ICH). RESEARCH DESIGN AND METHODS: This was a hospital-based prospective study The setting was an acute care 350-bed hospital in the city of Barcelona, Spain. Spontaneous ICH was diagnosed in 229 (11%) of 2,000 consecutive stroke patients included in a prospective stroke registry during a 10-year period. Main outcome measures were frequency of demographic variables, risk factors, clinical events, neuroimaging data, and outcome in ICH patients with and without diabetes. Variables related to vital status at discharge (alive or dead) in the univariate analysis plus age were studied in 4 logistical regression models. RESULTS: A total of 35 patients (15.3%) had diabetes. The overall in-hospital mortality rate was 54.3% in the diabetic group and 26.3% in the nondiabetic group (P < 0.001). Previous cerebral infarction, altered consciousness, sensory symptoms, cranial nerve palsy, multiple topography of the hematoma, intraventricular hemorrhage, and infectious complications were significantly more frequent in diabetic patients than in nondiabetic patients. The presence of diabetes was a significant predictive variable in the model based on demographic variables and cardiovascular risk factors (odds ratio 2.98 [95% CI 1.37-6.46]) and in the models based on these variables plus clinical variables (5.76 [2.01-16.51]), neuroimaging variables (5.59 [1.87-16.691), and outcome data (6.10 [2.04-18.291). CONCLUSIONS: Diabetes is an independent determinant of death after ICH. ICH in diabetic individuals presents some different clinical features compared with ICH in nondiabetic patients.

Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction.

The aim of the study was to compare demographic characteristics, anamnestic findings, cerebrovascular risk factors, and clinical and neuroimaging data of cardioembolic stroke patients with and without atrial fibrillation and of atherothrombotic stroke patients with and without atrial fibrillation. Predictors of early diagnosis of cardioembolic vs. atherothrombotic stroke infarction in atrial fibrillation patients were also determined. Data of cardioembolic stroke patients with (n=266) and without (n=81) atrial fibrillation and of atherothrombotic stroke patients with (n=75) and without (n=377) were obtained from 2000 consecutive patients included in the prospective Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry. Risk factors, clinical characteristics and neuroimaging features in these subgroups were compared. The independent predictive value of each variable on early diagnosis of stroke subtype was assessed with a logistic regression analysis. In-hospital mortality in patients with atrial fibrillation was significantly higher than in non-atrial fibrillation patients both in cardioembolic (32.6% vs. 14.8%, P<0. 005) and atherothrombotic stroke (29.3% vs. 18.8%, P<0.04). Valvular heart disease (odds ratio (OR) 4.6; 95% confidence interval (95% CI) 1.19-17.68) and sudden onset (OR 1.8; 95% CI 0.97-3.63) were predictors of cardioembolic stroke, and subacute onset (OR 8; 95% CI 1.29-49.42), COPD (OR 5.2; 95% CI 1.91-14.21), hypertension (OR 3. 63; 95% CI 1.92-6.85), hypercholesterolemia (OR 2.67; 95% CI 1.13-6. 28), transient ischaemic attack (OR 2.49; 95% CI 1.05-5.90), ischaemic heart disease (OR 2.30; 95% CI 1.15-4.60) and diabetes (OR 2.26; 95% CI 1.14-4.47) of atherothrombotic stroke. In conclusion, some clinical features at stroke onset may help clinicians to differentiate cerebral infarction subtypes in patients with atrial fibrillation. Atrial fibrillation is associated with a higher in-hospital mortality both in cardioembolic and atherothrombotic stroke patients.

Hemorrhagic lacunar stroke.

A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome (n = 439) and 7.4% of all cases of intracerebral hemorrhage (n = 229) entered in the database. Demographic, anamnestic, clinical and neuroimaging variables in patients with hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage and non-hemorrhagic lacunar stroke were compared. Predictors of hemorrhagic lacunar stroke were assessed by logistic regression analysis. Hypertension, cigarette smoking and involvement of the internal capsule were significantly more frequent in patients with hemorrhagic lacunar stroke than in those with non-lacunar intracerebral hemorrhage, whereas nausea and vomiting, altered consciousness, speech disturbances, hemianopia, and ventricular hemorrhage were significantly less frequent. As compared with non-hemorrhagic lacunar stroke, patients with hemorrhagic lacunar stroke were more likely to have hypertension, sudden stroke onset (minutes), head injury, headache, and basal ganglia involvement and less likely to have diabetes, gradual stroke onset (hours), and dysarthria. After multivariate analysis, only headache (OR 10.14), sudden onset (OR 9.89), and dysarthria (OR 0.10) were independent predictors of hemorrhagic lacunar stroke. Accordingly, the presence of headache and sudden onset of symptoms and absence of dysarthria may be useful signs for distinguishing hemorrhagic lacunar stroke from other causes of lacunar stroke.

Lacunar infarcts in patients aged 85 years and older.

OBJECTIVES: To compare the occurrence of lacunar infarcts in the very elderly ( > or = 85 years of age) and in patients below 85. MATERIAL AND METHODS: Data of 374 consecutive patients with lacunar infarcts were collected from a prospective hospital-based stroke registry in which 2000 patients are included. Distinctive clinical features of lacunar infarct in the very elderly were assessed by multiple logistic regression analysis. RESULTS: Lacunar infarcts were diagnosed in 39 (15%) of the 262 very elderly patients of our stroke registry. Lacunar infarcts in the very elderly accounted for 10.5% of all lacunes. There was no statistical difference in the occurrence of different lacunar syndromes between the very elderly patients and patients below 85. However, the very old group with lacunar infarct showed a significantly higher proportion of the female sex (56.4% vs 37.3%) and history of atrial fibrillation (28.2% vs 8.7%), chronic renal disease and pathologic condition and a significantly lower proportion of hypertension (61.5% vs 77.3%), diabetes (7.7%) vs 28.4%), ischemic heart disease, hypercholesterolemia, and absence of neurologic deficit at discharge from the hospital than patients below 85. After multivariate analysis only atrial fibrillation (OR = 3.77), female gender (OR =2.52), hypertension (OR = 0.35), and diabetes (OR = 0.16) were independent clinical factors for developing lacunar infarction in the very elderly. CONCLUSION: In the very elderly the higher occurrence of atrial fibrillation, the lower prevalence of hypertension and diabetes, and the greater focal neurological impairment suggest that the cardioembolic pathogenetic mechanisms may be more frequent than generally established for lacunar infarcts in stroke patients.

Acute stroke in very old people: clinical features and predictors of in-hospital mortality.

OBJECTIVES: To examine demographic characteristics, clinical features, neuroimaging data, and outcome of all acute stroke events occurring in individuals aged 85 years or older. DESIGN: Collection of data from a prospective hospital-based stroke registry. SETTING: Between January 1986 and December 1995, the data was collected of 2,000 stroke patients admitted consecutively to the department of neurology ( having 25 beds and an acute stroke unit) of Sagrat Cor-L'Alianza Hospital of Barcelona (an acute care, 350-bed teaching hospital serving a population of approximately 250,000). PARTICIPANTS AND MEASUREMENTS: For the purpose of this study, very old patients (aged 85 years or older) were selected (n = 262). The data of very old stroke patients were compared with the data of patients younger than 85 years of age (n = 1738). Predictors of in-hospital mortality based on clinical and neuroimaging variables were recorded within 48 hours of stroke onset, and outcome variables (medical complications that developed during hospitalization) were assessed by multiple regression analysis. RESULTS: The very old patients showed a significantly greater frequency of atherothrombotic (27.5% vs. 21.9%, P<.05) and cardioembolic infarctions (24.4% vs. 26.3%, P<.001) and a lesser frequency of stroke of unusual cause. Acute stroke in the very old patients was more severe than in patients younger than 85 years of age, with greater rates of in-hospital mortality (27% vs. 13.5%, P<.001), longer duration of hospital stay (22.03+/-29.6 vs. 17.5+/-21.5 days, P<.001), and lesser frequency of absence of neurologic deficit at the time of hospital discharge (21.4% vs. 33.1%, P<.001). Altered consciousness, limb weakness, sensory symptoms, involvement of the parietal lobe and temporal lobe, involvement of the internal capsule (with a protective effect), intraventricular hemorrhage, cardiac events, and respiratory events were selected as independent predictors of in-hospital mortality in the multivariate analysis. CONCLUSIONS: Very old patients with acute stroke showed a differential clinical profile, different frequency of stroke subtypes, and a poorer outcome compared with stroke patients who were younger than 85 years of age. Clinical and neuroimaging factors that are indicative of the severity of stroke and that were available at the time of the initial diagnosis and at the time of the development of cardiac and respiratory complications showed a predominant influence on in-hospital mortality and may help clinicians to establish prognosis more accurately.

[Clinical and care implications of the 10-year application of a cerebrovascular diseases register. Descriptive analysis of the last 1000 patients and comparative with the first 1000 patients]. / Implicaciones clínicas y asistenciales de la aplicación durante 10 años de un registro de enfermedades cerebrovasculares. Análisis descriptivo de los últimos 1.000 pacientes y comparativo con los 1.000 primeros pacientes.

BACKGROUND: There are few studies which analyze clinical and patients' care implications of the continuous application of acute stroke registry. PATIENTS AND METHODS: A prospective study was carried out on 2,000 consecutive patients with acute stroke who were admitted in the neurology department over a period of 10 years (1986-1995). A descriptive clinical analysis of the last 1,000 patients (1986-1991) and a comparative clinical analysis between the last 1,000 patients and the first 1,000 patients (1991-1995) were performed. CT scan and/or MRI were performed in all patients. We used a previously validated registry and we studied clinical and assistance implications of its systematic use. RESULTS: Between the last 1,000 patients and the first 1,000 patients there were significant differences in the frequency of transient ischaemic attacks (TIA) (15% vs 9%; p < 0.0001), lacunar infarcts (20.5% vs 17%; p < 0.04), cardioembolic infarcts (22.3% vs 12.4%; p < 0.0001), infarcts of undetermined cause (7.5% vs 15%; p < 0.0005), intraparenchymatous hemorrhage (9% vs 14%; p < 0.0005), in-hospital mortality (13.8% vs 16.7%; p = 0.07, NS) and mean length of hospital stay (16.5 vs 19.5 days; p < 0.005). CONCLUSIONS: The continuous application of stroke registry brought major interest to the care of stroke patients, resulting in a higher admission rate of TIA patients, a better diagnosis of cardioembolic and lacunar stroke and fewer infarcts of undetermined cause. A decrease in the mean length of hospital stay was observed as well as a lower in-hospital mortality rate.

Clinical predictors of early embolic recurrence in presumed cardioembolic stroke.

BACKGROUND: We determined clinical predictive factors of in-hospital embolic recurrence in presumed cardioembolic stroke patients by means of multivariate analysis based on clinical and neuroimaging prognostic variables assessed within 48 h of stroke onset. METHODS: Data of 347 consecutive patients with presumed cardioembolic stroke included in a prospective stroke registry were collected. Demographic characteristics, clinical events, and outcome in the recurrent and nonrecurrent embolization group were compared. The independent predictive value of each variable on the development of early embolic recurrence was analyzed in two multiple liner regression models - one based on eight demographic, anamnestic, and clinical variables and another based on 10 clinical, neuroimaging, and outcome variables. RESULTS: In-hospital recurrent embolization was diagnosed in 25 (6.9%) patients. The latency period was 12.1 days. The overall in-hospital mortality was 70.8% in the recurrent embolization group and 24.4% in the nonrecurrent embolization group (p < 0.001). Alcohol abuse, the combination of hypertension, valvular heart disease, and atrial fibrillation, nausea and vomiting, and previous cerebral infarction were predictors of recurrent embolization in the model based on clinical variables. In addition to these four variables, cardiac events were selected in the model based on clinical, neuroimaging, and outcome variables. CONCLUSIONS: A small number of clinical features that can be easily obtained on the patient's initial assessment may help clinicians to identify a subgroup of patients with cardioembolic stroke at the highest risk of developing early recurrent brain or systemic embolization.

Immunological characterization of a neuronal antibody (anti-Tr) associated with paraneoplastic cerebellar degeneration and Hodgkin's disease.

We studied an autoantibody (called anti-Tr), found in the serum and CSF of five patients with paraneoplastic cerebellar degeneration (PCD) and Hodgkin's disease (HD). Anti-Tr antibodies labelled the cytoplasm of Purkinje cells of human and rat cerebellum. The molecular layer of rat cerebellum showed a characteristic dotted pattern suggestive of immunoreactivity of dendritic spines of Purkinje cells. Patients with cerebellar disorders without HD (159) or HD without PCD (30) did not harbor anti-Tr antibodies. Immunoblots of human Purkinje cells or rat and mouse cerebellum were negative. Anti-Tr antibodies, as defined in this study, appear specific for HD-associated PCD. The immunohistochemical pattern described in the rat cerebellum coupled with the absence of reactivity in the immunoblot may be used to identify anti-Tr antibodies.