Michael Brainin

EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force

Neuroimaging techniques are necessary for the evaluation of stroke, one of the leading causes of death and neurological impairment in developed countries. The multiplicity of techniques available has increased the complexity of decision making for physicians. We performed a comprehensive review of the literature in English for the period 1965–2005 and critically assessed the relevant publications. The members of the panel reviewed and corrected an initial draft, until a consensus was reached on recommendations stratified according to the European Federation of Neurological Societies (EFNS) criteria. Non‐contrast computed tomography (CT) scan is the established imaging procedure for the initial evaluation of stroke patients. However, magnetic resonance imaging (MRI) has a higher sensitivity than CT for the demonstration of infarcted or ischemic areas and depicts well acute and chronic intracerebral hemorrhage. Perfusion and diffusion MRI together with MR angiography (MRA) are very helpful for the acute evaluation of patients with ischemic stroke. MRI and MRA are the recommended techniques for screening cerebral aneurysms and for the diagnosis of cerebral venous thrombosis and arterial dissection. For the non‐invasive study of extracranial vessels, MRA is less portable and more expensive than ultrasonography but it has higher sensitivity and specificity for carotid stenosis. Transcranial Doppler is very useful for monitoring arterial reperfusion after thrombolysis, for the diagnosis of intracranial stenosis and of right‐to‐left shunts, and for monitoring vasospasm after subarachnoid hemorrhage. Currently, single photon emission computed tomography and positron emission tomography have a more limited role in the evaluation of the acute stroke patient.

European Handbook of Neurological Management

The guidelines fall naturally into sections that cover: * Investigation: cerebrospinal fluid analysis, imaging, diagnostic antibodies and skin biopsy * Major neurological diseases: stroke, migraine, Parkinson’s disease, dystonia, mild traumatic brain injury, multiple sclerosis and Alzheimer’s disease * Neuromuscular diseases: motor neuron disease, inflammatory neuropathy, muscular dystrophy and myasthenia gravis * Infections: HIV infection and encephalitis * Neurological problems: treatment of neuropathic pain, acute relapses of multiple sclerosis and status epilepticus, to name but a few * Sleep disorders: Narcolepsy, other sleep disorders and restless legs syndrome * Cognitive rehabilitation.

Acute stroke treatment in Europe: a questionnaire‐based survey on behalf of the EFNS Task Force on acute neurological stroke care

In 1997 the EFNS Task Force on Acute Neurological Stroke Care published its recommendations for acute stroke care ( Brainin et al., 1997 ), which, in 1999, was followed by a stroke care inventory ( Brainin et al., 2000 ) assessing the development of acute stroke care. In 2000 all 33 members of the EFNS Stroke Scientist Panel were asked to complete a questionnaire on the treatment of acute stroke in their country as of 2000. Data were based either on national surveys or a personal estimate of national practice, together with data from the personal practice of the panel member. Data from 22 countries were received. One of the principal findings is the lack of systematic evidence about practice in a significant number of European countries. Results illustrate that neurologists have a leading role in implementing acute stroke treatment guidelines and in adopting new therapeutic methods in most countries, but there is a wide variation in the application of different therapeutic procedures.

Dyslipidemia, elevated LDL cholesterol and reduced nocturnal blood pressure dipping denote lacunar strokes occurring during nighttime

Previous studies have shown a peak occurrence of ischemic stroke in the morning but no consistent finding has been attributed to this. Focused on lacunar strokes we performed a prospective study with a detailed diagnostic protocol including parameters of recent infection, indicators of sleep apnea and cerebral vasoreactivity (CVR), aimed at defining differences in risk profiles between diurnal and nocturnal strokes. Consecutively we included 33 nocturnal and 54 diurnal strokes. Baseline characteristics, known risk factors, stroke severity and topology were not different between groups. The mean low‐density lipoprotein (LDL) cholesterol level was significantly higher amongst patients with nocturnal strokes (133.3 ± 35.2 mg/dl vs. 115.5 ± 39.8 mg/dl; P = 0.04), as well as the proportion of patients with any dyslipidemia (94% vs. 77.8%; P = 0.047). Twenty‐four‐hour blood pressure recordings showed a reduced nocturnal decrease of blood pressure in subjects with strokes that occurred between 10 pm and 6 am in comparison with those whose strokes occurred between 6 am and 2 pm (5.0 ± 7.3% vs. 11.0 ± 6.7%; P = 0.049). No significant differences were found for parameters of recent infection (including seroreactivity against Chlamydia pneumoniae and cytomegalovirus), CVR, indicators of sleep apnea and the degree of white matter disease assessed by magnetic resonance tomography. Dyslipidemia, especially elevated LDL cholesterol is more prevalent in nocturnal lacunar strokes especially when combined with a reduced nocturnal dipping of blood pressure. This risk factor profile can be regarded as an additional target for stroke prevention.

Thrombolytic therapy for acute stroke in Austria: data from the Safe Implementation of Thrombolysis in Stroke (SITS) register.

Background:  We aimed at determining the safety and efficacy of IV alteplase in Austrian versus non‐Austrian centres as documented in the Internet‐based registers Safe Implementation of Thrombolysis for Stroke – MOnitoring STudy (SITS‐MOST) and – International Stroke Thrombolysis Register (SITS‐ISTR).

Endovascular stroke therapy in Austria: a nationwide 1-year experience.

Based on a tight network of stroke units (SUs) and interventional centres, endovascular treatment of acute major intracranial vessel occlusion has been widely implemented in Austria. Documentation of all patients in the nationwide SU registry has thereby become mandatory.

Emerging scientific opportunities for junior neurologists in the European Federation of Neurological Societies

Close collaboration between the European Association of Young Neurologists and Trainees (EAYNT) and the European Federation of Neurological Societies (EFNS) has lead to the introduction of various scientific opportunities for young neurologists at an international level. These include participation in the activities of the Scientist Panels, inclusive of workshop proposals for future congresses, task forces, guideline development and abstract reviewing. Furthermore, the EFNS acknowledges scientific contribution by junior colleagues with congress bursaries and the Uschi Tschabitscher Prize. The EAYNT, in cooperation with the EFNS, is devoted to promote the involvement of talented junior neurologists in the shaping of European neurology in the future.

Multidomain intervention for the prevention of cognitive decline after stroke - a pooled patient-level data analysis

The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke.

Comment from the EFNS Scientific Committee on the letter from Gunther Haag concerning Bendsten L et al. EFNS guideline on the treatment of tension-type headache--report of an EFNS task force. Eur J Neurol 2010; 17: 1318-1325.

Donauuniversität Krems, Centre of Neurosciences, Krems, Austria; University of Roma La Sapienza, Department of Neurological Sciences, Rome, Italy; Ghent University Hospital, Department of Neurology. Ghent, Belgium; Haukeland University Hospital, Department of Neurology, Bergen, Norway; Hôpital B Roger Salengro CHRU, Department of Neurology B, Lille, France; Rehabilitationskrankenhaus, Ulm Department of Neurology. Ulm, Germany; Royal Free and University College Medical School, Department of Clinical Neurosciences, London, UK; Neurology Clinic of City Hospital, N 31 Department of Neurology, Moscow, Russia

Chapter 18. Post-Polio Syndrome

Da Chapter 18 Post-polio syndrome E. Farbu, N. E. Gilhus, M. P. Barnes, K. Borg, M. de Visser, R. Howard, F. Nollet, J. Opara, E. Stalberg Stavanger University Hospital, Norway; University of Bergen, and Haukeland University Hospital, Bergen, Norway; Hunters Moor Hospital, Newcastle upon Tyne, UK; Karolinska Intitutet/Karolinska Hospital, Stochkholm, Sweden; University of Amsterdam, 1100 DD Amsterdam, The Netherlands; St Thomas’ Hospital, London, UK; Repty Rehab Centre. ul. Sniadeckio 1, PL 42-604 Tarnowskie Góry, Poland; University Hospital, S-75185 Uppsala, Sweden