How to improve access to appropriate therapy and outcome of the acute ischemic stroke: a 24-month survey of a specific pre-hospital planning in Northern Italy.

Few patients with acute cerebral infarction are medicated with thrombolysis as yet. Thus, a specific plan was created in the area of Bergamo in Northern Italy to increase the number of procedures. The plan, started in 2010, consisted of: (1) subdivision of the area of Bergamo into three zones, each one served by a single Stroke-Unit (SU) licensed to thrombolysis; (2) information to population via newspapers and local broadcasting; and (3) teachings both to personnel of Emergency Medical Service and General Practitioners.

Predictors of re-canalisation in acute cerebral infarction from occlusion of the terminal internal carotid artery or of the middle cerebral artery mainstem treated with thrombolysis.

Objective: We have evaluated the factors of unsuccessful re-canalisation in a large series of patients with hemispheric cerebral infarction treated with thrombolysis.

Patients And Methods: All patients aged 18-80 years with an acute hemispheric infarction, admitted within the first few hours of symptoms onset, were immediately submitted to Magnetic Resonance both Imaging (MRI) and Angiography (MRA). MRI and MRA were repeated at 24 h of stroke.

Stroke-Unit and emergency medical service: a 48-month experience in northern Italy.

Since the therapeutic window for acute ischaemic stroke is very short, early arrival at emergency care rooms is mandatory. Emergency medical service (EMS), assuring fast patients transportations, plays a fundamental role in the management of stroke. We have prospectively analysed the utilisation of EMS in the management of stroke patients in a countryside area of northern Italy.

C-reactive protein levels in the first three hours after acute cerebral infarction.

Background: Although thought to be involved in the precipitation of the acute ischemic stroke, C-reactive protein (CRP) was scarcely investigated in the first few hours of a cerebral infarction.

Patients And Methods: CRP was measured in a consecutive series of patients within the first 3 h of the onset of a first-ever acute cerebral infarction, and in control inpatients, matched for sex and age (±2 years).

Results: Three hundred eighty-seven stroke patients and 387 controls were enrolled.

Migraine and cerebral infarction in young people.

The objective of this study is to investigate relationship between migraine and cerebral infarction in young people. Patients aging 16-44 years, referred for stroke and age- and gender-matched controls were investigated for migraine following the International Headache Society criteria. Included people were 314 strokes and 314 controls.

C-reactive protein and aetiological subtypes of cerebral infarction.

Objective: We have sought to relate C-reactive protein (CRP), a peripheral marker of inflammation frequently elevated in stroke patients, with aetiology and prognosis of acute cerebral infarction.

Patients And Methods: Patients were included after a first-ever CT/MR documented cerebral infarction. CRP was measured from blood samples taken within the 6th hour of the onset.

Headache and botulinum toxin.

The authors discuss clinical and international experience about botulinum toxins (BTX types A and B) in headache treatment. Data from literature suggest good results for the treatment of tension-type headache, migraine and chronic tension-type headache. In the present paper mechanisms of action and injection sites will also be discussed.

Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions.

Background And Purpose: Heparin is widely used for acute stroke to prevent thrombus propagation and/or multiple emboli generation, although there is, as yet, no demonstrated efficacy. However, all of the available clinical studies allowed long intervals from stroke to treatment. The purpose of this study was to try an intravenous regimen of unfractionated heparin the acute cerebral infarction starting treatment within the first 3 hours of the onset of symptoms.