An incremental stroke protocol that includes CT perfusion increases diagnostic performance for stroke diagnosis and inter- and intraobserver agreement.

Summary:Purpose: Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure.Methods: We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure-exposed students.Results: Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug-induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure-exposed group showed better knowledge but equivalent attitudes compared with the naïve group.Conclusions: Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.

Background and Purpose-The Alberta Stroke program early CT score (ASPECTS) is a semiquantative scale for estimating extent and distribution of early ischemic changes within the MCA territory in the acute stroke setting. Good interobserver agreement of total ASPECTS is demonstrated for noncontrast CT (NCCT) and other imaging modalities. Our purpose is to assess interobserver agreement for individual ASPECTS regions for different imaging modalities. Methods-One hundred and eighty-one consecutive patients presenting with acute stroke symptoms within 4.5 hours of onset were included. Four readers assigned total and individual ASPECTS for NCCT, CT angiography source images (CTA-SI), and CTP maps of cerebral blood volume (CTP-CBV). Interobserver agreement was assessed by measuring internal consistency and concordance of total and individual ASPECTS using Cronbach's α and intraclass correlation coefficient, respectively. Results-Total ASPECTS demonstrated very good concordance and internal consistency for all 3 modalities. Intraclass correlation coefficient and Cronbach's α were 0.834 and 0.859 for NCCT, 0.876 and 0.894 for CTA, and 0.903 and 0.911 for CTP-CBV, respectively. Performance for individual ASPECTS regions was inferior to total ASPECTS, but incremental improvement in interobserver reliability was demonstrated for NCCT, CTA-SI, and CTP-CBV, respectively. Highest concordance was shown for caudate, lentiform, and M1-M3, whereas performance for internal capsule and M4-M6 was poorer. Conclusions-CTP-CBV