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Objective Prehospital delay is the major cause of treatment delay in stroke. This study was conducted to clarify the contribution of specific stroke-related symptoms to prehospital delay. Methods A consecutive series of 469 patients hospitalized within 2 weeks of stroke onset was collected. In this study, prehospital delay was defined as the time interval from recognition of stroke-related symptoms to hospital arrival. The prevalence of each symptom or sign and prehospital delay were analyzed. Results Weakness of the lower limb (43.5%) was the most common symptom followed by weakness of the upper limb (37.1%) and dysarthria (31.6%). Conversely, the most common sign was weakness of the upper limb (54.1%) followed by dysarthria (53.3%), weakness of the lower limb (53.1%), and sensory disturbance (39.0%). The presence of confusion/decreased level of consciousness (p<0.001), aphasia (p<0.001), headache (p=0.017), and nausea/vomiting (p=0.035) were associated with earlier hospital visitation compared with the absence of these symptoms in univariate analyses. Conversely, the presence of sensory disturbance (p= 0.0017) and vertigo/dizziness (p=0.044) were associated with a significant delay in hospital visitation compared with the absence of these symptoms. There was a discrepancy in the prevalence between symptoms recognized by the patients or bystanders and signs diagnosed by the physicians. Conclusion There was a significant overall correlation between prehospital delay and the National Institute of Health Stroke Scale scores. Public education is therefore necessary to encourage early hospital visitation even with the appearance of mild symptoms.

We describe three siblings with hyperparathyroidism due to multiple parathyroid adenomas without evidence of other endocrinological abnormalities. A 22-year-old woman had two parathyroid adenomas complicated by multiple ossifying jaw fibromas. Her sister, aged 29, also suffered from primary hyperparathyroidism associated with two parathyroid adenomas one of which was also suspected to be a carcinoma. These two female patients had unusual multiple small uterine polyps, which were diagnosed as adenomyomatous polyps. Their brother, aged 17, had two parathyroid adenomas complicated by urolithiasis. These three patients are characterized by young adult-onset familial isolated hyperparathyroidism due to multiple adenomas with various complications including ossifying jaw fibroma and uterine adenomyomatous polyps. These clinical features are different from those of familial hyperparathyroidism associated with multiple endocrine neoplasia.

Objective: Time is an important factor in treating stroke patients. Symptoms which are recognized by patients and/or bystander seem to influence how soon they visit the hospital. Here we examined this issue. Materials and Methods: A consecutive series of 469 patients was collected prospectively between May 2007 and March 2009. All patients were admitted within 2 weeks after the onset. Median age of patients was 75 years old. Results: The median time interval between recognition of symptoms and hospital visit (“delay”) was 6.6 hours. Interview from patients and/or bystander revealed that they recognized disturbance of consciousness (“Cons”) in 83, dysarthria in 148, aphasia in 23, facial weakness (“Facial”) in 25, weakness of upper limb (“U/E”) in 174, weakness of lower limb (“L/E”) in 204, sensory disturbance (“Sensory”) in 63, visual problem (“Visual”) in 11, headache in 53, nausea and/or vomiting (“N/V”) in 57, and lightheadedness in 57, respectively. The median “delay” with each symptom was 1.0h with “Cons”, 1.1h with aphasia, 2.4h with headache, 2.4h with “N/V”, 3.6h with “Facial”, 5.1h with “U/E”, 5.9h with dysarthria, 8.3h with “Visual”, 10.2h with “L/E”, 16.6h with lightheadedness, and 24.7h with “Sensory”, respectively. Median NIHSS score at the initial examination (iNIHSS) was 4.0. There was a significant negative correlation between “delay” and iNIHSS in overall, “Cons”, dysarthria, “U/E”, “L/E” and “Sensory”, but not in aphasia, “Facial”, “Visual”, headache, “N/V”, and lightheadedness. Neurological examination by board-certified strokologists revealed “Cons” in 110, dysarthria in 250, aphasia in 72, “Facial” in 167, “U/E” in 254, “L/E” in 249, “Sensory” in 183, and “Visual” in 33, respectively. This means that only 15% of “Facial”, 32% of aphasia, 33% of “Visual”, and 34% of “Sensory” was recognized by patients and/or bystander, respectively. Conclusions: There was a significant negative correlation between “delay” and iNIHSS; however, there were several symptoms which caused early hospital visit regardless of severity of iNIHSS. Aphasia and “Facial” caused early hospital visit, however, only 15% and 32% of patients and/or bystander recognized these symptoms, respectively. The enlightenment to the general public is required.

Objective: Stroke should be treated immediately after the onset; however, a variety of factors cause delay of hospital visit. Here we examined this issue focusing on the social factors. Materials and Methods: A consecutive series of 469 patients was collected prospectively between May 2007 and March 2009. All patients were admitted within 2 weeks after the onset of stroke. Median age of patients was 75 years old. Results: Median time between the onset of stroke and hospital visit (“delay”) was 12.7 hours, ranging from 0.1 to 333.6. Ninety-two patients (20%) lived alone and 377 patients lived with their family or stayed at nursery homes. There was no significant difference in “delay” among them (p=0.41). The “delay” was further analyzed according to the styles of living together in 377 patients. Living with spouse caused a significant delay in hospital visit comparing to living at nursery homes (p=0.0001) and to living with their children (p=0.004), respectively. Living styles was categorized in 3 patterns; i.e., living alone (“alone”), living with spouse (“spouse”), and others (“others”). Median “delay” was 14.8 hours in “alone”, 18.9 hours in “spouse”, and 8.25 hours in “others”, respectively. There was a significant difference between “alone” and “others” (p=0.018), and between “spouse” and “others” (p<0.0001), respectively. Knowledge of rt-PA and use of ambulance cars significantly caused an earlier visit to the hospital (p=0.0006 and p<0.0001, respectively). On the other hand, consultation to family doctors, even by telephone, caused a significant delay of hospital visit (p<0.0001). Two hundred and eighty-eight patients recognized the symptoms by themselves and it was also a significant factor for the delay of hospital visit (p<0.0001). The after-hours onset of stroke was not a causative factor for the delay of hospital visit. Conclusions: Both living with spouse and living alone were risk factors for the delay of hospital visit. Knowledge of rt-PA, use of ambulance cars caused early hospital visit. Consultation to family doctors, even by telephone, and recognition of symptoms by patients themselves caused delay of hospital visit. The after-hours onset of stroke did not affect “delay”. The enlightenment to the general public is required.