Recently it has been shown that effective treatment for acute stroke must be initiated within 3–6 h from onset. In order to determine whether this is feasible and the reasons for delayed presentation, a prospective study was conducted in a community hospital in Israel. Of the 216 patients enrolled, 18% arrived at the hospital within 90 min of stroke onset and 54% presented within 6 h. Important factors associated with early presentation included major stroke (as compared to mild stroke) and time of day of onset (afternoon as compared with nighttime). Further efforts must be made to shorten the delay in hospital arrival of acute stroke patients.

In three patients with intracranial meningioma, several episodes resembling classical transient ischemic attacks caused a significant delay in the correct diagnosis. It seems that this diagnostic ‘pitfall’ is not rare. The mechanism of such episodes also known as ‘transient tumor attacks’ might be of vascular origin.

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