The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke.

Abstract

We present epidemiologic, etiologic, and clinical data for 1,000 consecutive patients with a first stroke (cerebral infarction or hemorrhage) admitted to the Centre Hospitalier Universitaire Vaudois since 1982. The patients were evaluated using a standard protocol of tests (computed tomography, Doppler ultrasonography, and electrocardiography in all patients, as well as angiography and specific cardiac investigations in selected patients). Each case was coded prospectively into a computerized registry. We believe that the Lausanne Stroke Registry is the first registry with complete computed tomography and Doppler ultrasonography data on all patients, which allows correlation between clinical findings, presumed etiology, and stroke location. Although the Lausanne Stroke Registry is not population-based, it gives a good estimate of the stroke-related problems in patients admitted to a primary-care center since our hospital is the sole acute-care facility for stroke in the Lausanne area. (Stroke 1988; 19:1083-1092) S troke data banks can provide the best available information for unanswered questions relative to diagnosis and management of patients with cerebrovascular disease.1 One of the best stroke registries recorded 694 patients 2 but lacked uniform computed tomography (CT) and ultrasonography data. In two more recent registries, 3 -5 CT was obtained in 90% of the patients, allowing an accurate diagnosis of hemorrhagic versus ischemic stroke. Data from other stroke registries have been published, 6 -8 but clinical details were often scarce and specific investigations were not performed systematically.We set up our own registry in 1983 using systematic computer coding of data from patients admitted with their first stroke. Although ours was not a population-based registry, we believed that the information given by the registry would be of great value because most acute stroke patients are referred to the Centre Hospitalier Universitaire Vaudois, which is the only public hospital in the Lausanne area and is located in a city of 200,000 people. Moreover, this hospital has the only department of neurology in the entire county. Subjects and MethodsInformation from all patients with a first stroke (cerebral infarction or hemorrhage, neurologic deficit lasting >24 hours) admitted since 1982 have been prospectively coded and entered into a computerized data bank. This article presents the analysis of the first 1,000 patients. Patients with pure subarachnoid hemorrhages and recurrent stroke have been excluded. Systematic investigations performed in every patient included brain CT (one to five examinations) with and without contrast (except in patients with known allergy), Doppler ultrasonography with frequency spectral analysis (common, external, and internal carotid arteries; vertebral arteries at the retromastoid level; subclavian arteries; ophthalmic arteries), twelve-lead electrocardiography (ECG), and standard blood and urine tests including venous hematocrit and fasting blood cholesterol concentration. Cerebral ...

Human thalamus contributes to perceptual stability across eye movements

“…The affected portions of central thalamus closely correspond to homologous portions of primate thalamus in which saccade-and eye positionrelated signals have been recorded previously (13,17). Although single lesions affecting the thalamus are occasionally encountered in larger cohorts of stroke patients (18), oculomotor abnormalities and other neurological and cognitive deficits are observed in the vast majority of these patients (14,19). Screening of the medical records and imaging databases in our department (>2,000 stroke patients/year) yielded no further subjects with unilateral lesions of similar selectivity in our thalamic region of interest.…”

Duplex ultrasonography for the detection of vertebral artery stenosis

“…About 25% of all strokes are posterior circulation strokes (Bamford, Sandercock, Dennis, Burn, & Warlow, 1991;Bogousslavsky, van Melle, & Regli, 1988). Vertebrobasilar stenosis is an important cause of posterior circulation stroke and is found in 26.2% patients with such stroke (Marquardt, Kuker, Chandratheva, Geraghty, & Rothwell, 2009).…”

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

“…Each year in the United States, it affects 730,000 to 760,000 patients, a third of whom will be permanently disabled, and thus represents the leading cause of disability in the country. 1,2 Thrombolysis has been introduced as a new therapy for acute stroke, 3 but present indications for intravenous thrombolytic therapy depend on the time interval since the onset of symptoms (less than 3 hours) and noncontrast cerebral computed tomography (CT) findings (absence of cerebral hemorrhage and extent of the cerebral hypodensity). 1,3,4 Evaluation of brain perfusion prior to thrombolysis has been suggested as a possible selection criterion for treatment, since extensive infarct and little salvageable penumbra in the territory of an occluded middle cerebral artery (MCA) seem to be linked to an unfavorable riskbenefit ratio.…”