We assessed the risk and determined predictors of early epileptic seizures (ES) in patients with acute cerebral venous and sinus thrombosis (CVST). A prospective series of 194 consecutive patients with acute CVST admitted to neurological wards in two German university hospitals was analysed for frequency of ES and in-hospital mortality. Demographic, clinical and radiological characteristics during the acute stage were retrospectively analysed for significant association with ES in univariate and multivariate analyses. During the acute stage, 19 patients (9.8%) died. Early symptomatic seizures were found in 86 patients (44.3%). Status epilepticus occurred in 11 patients (12.8%) of whom four died. Amongst patients with epileptic seizures, mortality was three times higher in those with status than in those without (36.4% and 12%, respectively). In multivariate logistic regression analysis, motor deficit [odds ratio (OR) 5.8; 95% CI 2.98-11.42; P < 0.001], intracranial haemorrhage (OR 2.8; 95% CI 1.46-5.56; P = 0.002) and cortical vein thrombosis (OR 2.9; 95% CI 1.43-5.96; P = 0.003) were independent predictors of early epileptic seizures. Status epilepticus was an important source of morbidity and early mortality in patients with CVST in this study. Patients with focal motor deficits, cortical vein thrombosis and intracranial haemorrhage carried the highest risk for ES. Prophylactic antiepileptic treatment may be an option for these patients.

Objective: To assess the risk of recurrence of cerebral venous and sinus thrombosis (CVST) during subsequent pregnancy and puerperium in women with previous cerebral venous occlusive disease. Methods: The authors retrospectively studied the relapse rate of CVST and the incidence of extracerebral venous thrombosis during subsequent pregnancies in 39 women (from 125 patients with CVST) who suffered a CVST at childbearing age. Results: Mean follow up was 10.25 years (range 1 to 20). Twenty two pregnancies and 19 births were observed in 14 women without evidence of either recurrence of CVST or extracerebral venous thrombosis. One pregnancy occurred during oral anticoagulation and was interrupted and two pregnancies ended with spontaneous abortions. Low dose heparin had been given during five pregnancies. Conclusions: The risk of recurrence for CVST during pregnancy seems to be low and these data do not justify a negative advice on pregnancy in women with previous CVST. Further studies are needed to evaluate the need for a prophylactic anticoagulation during pregnancy and puerperium.H ormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism (VTE) including cerebral venous and sinus thrombosis (CVST).1-3 Very little is known about the relapse rate during pregnancy and puerperium in women with a history of CVST. As CVST is nowadays largely a disease of younger women and hormonal factors such as the intake of oral contraceptives 4 5 or pregnancy are important risk factors in a large proportion of female patients, counselling of such women regarding future pregnancies remains a problem in clinical practice. We studied the course and complications of further pregnancies as well as the relapse rate in women with previous CVST at childbearing age. PATIENTS AND METHODSA total of 125 consecutive patients with CVST treated between 1976 and 1996 were identified from hospital charts. Diagnosis had been confirmed by conventional angiography or magnetic resonance angiography in all patients. Eighteen patients (14.6%) had died during the acute stage and 12 had died during the follow up period. Additional 10 patients were lost to follow up and three refused to participate in the study. The remaining 82 patients were eligible for the study. Of these, 39 (47.5%) were women and had been at childbearing age (18-40 years) when the CVST occurred.Data were obtained by phone interviews using a standardised questionnaire. It contained questions on the CVST relapse rate and the long term outcome and was sent to all 82 patients. One part of the questionnaire focused on subsequent pregnancies asking for (1) recurrence of CVST (and its delay to the previous CVST and how the diagnosis was established) (2) incidence of other venous thrombotic events (3) incidence of other pregnancy related complications, and (4) the use and duration of anticoagulation with heparin. Patients who declined a telephone interview were sent the questionnaire by mail. If questions were not or equivocally answered in the mailed...

Communication skills training is an accepted part of undergraduate medical programs nowadays. In addition to learning experiences its importance should be emphasised by performance-based assessment. As detailed checklists have been shown to be not well suited for the assessment of communication skills for different reasons, this study aimed to validate a global rating scale. A Canadian instrument was translated to German and adapted to assess students' communication skills during an end-of-semester-OSCE. Subjects were second and third year medical students at the reformed track of the Charité-Universitaetsmedizin Berlin. Different groups of raters were trained to assess students' communication skills using the global rating scale. Validity testing included concurrent validity and construct validity: Judgements of different groups of raters were compared to expert ratings as a defined gold standard. Furthermore, the amount of agreement between scores obtained with this global rating scale and a different instrument for assessing communication skills was determined. Results show that communication skills can be validly assessed by trained non-expert raters as well as standardised patients using this instrument.

For quality assurance medical schools have to support SP-programs adequately. SP trainers should be introduced into German SP programs to release medical doctors from SP training and organisational tasks. Networking, as carried out internationally, should be introduced to foster collaborative research and effectively use limited resources.