Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia.

A 21-year-old woman presented to the emergency department 1 day after a fall. On the day of presentation, she awoke with horizontal diplopia and posterior neck pain. Based on clinical findings, she was diagnosed with bilateral internuclear ophthalmoplegia.

The impact of a stroke prevention clinic in diagnosing modifiable risk factors for stroke.

Objective: To evaluate the referral patterns of patients to a stroke prevention clinic (SPC) and to test the adequacy of prereferral diagnosis and management of modifiable risk factors for stroke.

Methods: We collected prospective data on consecutive patients referred to the SPC at University of Alberta Hospital in Edmonton, Alberta, Canada. Outcome measures included: alternate diagnoses to stroke or transient ischemic attack (TIA), uncontrolled or undiagnosed hypertension, hyperlipidemia and diabetes, therapies, and investigations leading to carotid endarterectomy.

Can rt-PA be administered to the wrong patient? Two patients with somatoform disorder.

Background: Intravenous rt-PA (i.v. rt-PA) for acute stroke has raised many concerns, including its inadvertent use in patients presenting with acute stroke-like symptoms as the expression of their somatoform disorder.

Atrial myxoma as a cause of stroke: case report and discussion.

Cardiac myxoma is a source of emboli to the central nervous system and elsewhere in the vascular tree. However, nonspecific systemic symptoms and minor embolic phenomena may be overlooked in the absence of any history of cardiac problems. In this situation, cardiac investigations may not be performed, and diagnosis of this rare condition may be delayed until the onset of more significant embolic disease, such as stroke with functional impairment, as in the case reported here.

Auditing carotid endarterectomy: a regional experience.

Background: Proof from randomized controlled trials that carotid endarterectomy (CEA) is efficacious in stroke prevention has resulted in a large resurgence of its use in recent years. We wished to determine if patients in our region were being selected and treated with complication rates consistent with the randomized trials.

Methods: We have completed four audits of CEAs performed in our region since 1994, each followed by feed-back of results to the participating surgeons.

Echocardiographic findings of patients with retinal ischemia or embolism.

Background And Purpose: A potential source of emboli is not detected in more than 50% of patients with retinal arterial occlusive events. Echocardiographic studies are not always included in the diagnostic workup of these patients. The authors studied the diagnostic yield of transthoracic (TTE) and/or transesophageal (TEE) echocardiography in identifying potential sources of emboli in patients with retinal ischemia or embolism.

How well are hypertension, hyperlipidemia, diabetes, and smoking managed after a stroke or transient ischemic attack?

Background And Purpose: Stroke prevention clinics (SPCs) are not usually involved with the active management of hypertension, hyperlipidemia, diabetes, and smoking. The effect of consultations generated at SPCs on the adequacy of the management of these risk factors for stroke has not been well described, and few studies have long-term follow-up.

Methods: We performed a prospective study of 119 consecutive patients referred to an SPC for secondary prevention.