The economics of treating stroke as an acute brain attack

Abstract Currently, treatments for ischemic stroke focus on restoring or improving perfusion to the ischemic area using thrombolytics. The increased hospitalization costs related to thrombolysis are offset by a decrease in rehabilitation costs, for a net cost savings to the healthcare system. However, early treatment is essential. The benefit of thrombolysis is time-dependent but only a very small proportion of patients, 2%, are presently being treated with tPA. In the United States, if the proportion of all ischemic stroke patients that receive tPA were increased to 4, 6, 8, 10, 15, or 20%, the realized cost saving would be approximately $ 15, 22, 30, 37, 55, and 74 million, respectively. Being so, efforts should be made to educate the public and paramedics regarding early stroke signs. Furthermore, additional acute stroke therapy training programs need to be established for emergency departments. Finally, hospital systems need to be re-engineered to treat patients as quickly as possible in order to optimize thrombolytic benefit as well as maximize cost-effectiveness.</p

Universal Connection through Art: Role of Mirror Neurons in Art Production and Reception.

Art is defined as expression or application of human creative skill and imagination producing works to be appreciated primarily for their aesthetic value or emotional power. This definition encompasses two very important elements—the creation and reception of art—and by doing so it establishes a link, a dialogue between the artist and spectator. From the evolutionary biological perspective, activities need to have an immediate or remote effect on the population through improving survival, gene selection, and environmental adjustment, and this includes art. It may serve as a universal means of communication bypassing time, cultural, ethnic, and social differences. The neurological mechanisms of both art production and appreciation are researched by neuroscientists and discussed both in terms of healthy brain biology and complex neuronal networking perspectives. In this paper, we describe folk art and the issue of symbolic archetypes in psychoanalytic thought as well as offer neuronal mechanisms for art by emphasizing mirror/neurons and the role they play in it

Frequency, characterisation and therapies of fatigue after stroke

Post-stroke objective or subjective fatigue occurs in around 50% of patients and is frequent (30%) even after minor strokes. It can last more than one year after the event, and is characterised by a different quality from usual fatigue and good response to rest. Associated risk factors include age, single patients, female, disability, depression, attentional impairment and sometimes posterior strokes, but also inactivity, overweight, alcohol and sleep apnoea syndrome. There are few therapy studies, but treatment may include low-intensity training, cognitive therapy, treatment of associated depression, wakefulness-promoting agents like modafinil, correction of risk factors and adaptation of activitie

Revue des hospitalisations du Service de neurologie du CHUV en 1997

La présente étude s'inscrit dans la continuité des revues d'hospitalisation déjà conduites au CHUV. Elle consiste à documenter la pertinence des admissions et des journées d'hospitalisation dans le Service de neurologie pour les patients admis entre le 1er octobre 1996 et le 30 mars 1997. Soutenue par le Fonds de performance vaudois, cette étude pousuit trois buts: 1. vérifier l'applicabilité du protocole de Gertman et Restuccia au contexte de la neurologie; 2. élaborer un instrument de détection des journées non justifiées; 3. identifier les mesures permettant de diminuer le taux de journées non justifiées (...). [Table des matières] 1. Matériel et méthode. 1.1. Protocole princeps. 1.2. Protocole adapté. 1.3. Analyse des causes de délai. 2. Résultats : exhaustivité de la cueillette de données. 3. Discussion et conclusions. 4. Annexes : 1. Limites temporelles du critère C15. 2. Soins requis (PNR). 3. Formulaire de saisie. 4. Responsabilités des délais. 5. Distribution des critères. 6. Causes de délai

Pure superficial posterior cerebral artery territory infarction in The Lausanne Stroke Registry

Abstract.: Objective:: To determine the patterns of clinical presentation, lesion topography, and etiology in patients with ischemic stroke limited to the superficial territory of the posterior cerebral artery (s-PCA). Methods:: In the Lausanne Stroke Registry (LSR, 1983-1998), we determined the patterns of clinical presentation, lesion topography and mechanisms of stroke, among 117 patients with s-PCA infarction (s-PCAI) on brain imaging. Results:: s-PCAIs accounted for 30.5 % of all PCA territory ischemic strokes. The presumed etiology was embolism in 64 (54.5 %) patients [cardiac in 51 (43.5 %) and arterial in 13 (11 %)], indeterminate in 38 (32 %), PCA atherothrombosis in 4 (3.4 %), migraine in 4 (3.4 %), other rare causes in 4 (3.4 %), and multiple potential sources of embolism in 3 (2.5 %). The clinical findings were hemianopsia in 78 (67 %), quadrantanopsia in 26 (22 %), and bilateral visual field defects in 8 (7 %). Motor, sensory, or sensorimotor deficits were detected in 14 (12 %), 8 (6.8 %), or 8 (6.8 %) patients, respectively. Neuropsychological dysfunction included memory impairment in 20 (17.5 %; with left [L], right [R], or bilateral [B] lesions in 15, 2, or 3 patients, respectively), dysphasia in 17 (14.5 %; L/B: 14/3), dyslexia with dysgraphia in 5 (4 %; L/B: 4/1), dyslexia without dysgraphia in 10 (8.5 %; L/B: 8/2), hallucinations in 12 (10 %; L/R/B: 5/5/2), visual neglect in 11 (9.5 %; L/R: 2/9), visual agnosia in 10 (8.5 %; L/B: 7/3), prosopagnosia in 7 (6 %; R/B: 4/3), and color dysnomia in 6 (5 %; L: 6). Conclusions:: s-PCAIs are uncommon, representing less than a third of all PCA infarctions. Although embolism is the main cause in 60 % of patients, identification of the emboli source is often not possible. In 1/3 of cases, the stroke mechanism cannot be determined. Neuropsychological deficits are frequent if systematically searched fo

Three Essays on Predictability and Seasonality in the Cross-Section of Stock Returns

This thesis examines predictability and seasonality in the cross-section of stock returns. The first chapter, titled ``Infrequent Rebalancing, Return Autocorrelation, and Seasonality,'' shows that a model of infrequent rebalancing can explain specific predictability patterns in the time series and cross-section of stock returns. First, infrequent rebalancing produces return autocorrelations that are consistent with empirical evidence from intraday returns and new evidence from daily returns. Autocorrelations can switch sign and become positive at the rebalancing horizon. Second, the cross-sectional variance in expected returns is larger when more traders rebalance. This effect generates seasonality in the cross-section of stock returns, which can help explain available empirical evidence. The second chapter, titled ``Seasonalities in Anomalies,'' investigates return seasonalities in a set of well-known anomalies in the cross-section of U.S. stocks returns. A January seasonality goes beyond a size effect and strongly affects most anomalies, which can even switch sign in January. Both tax-loss selling and firm size are important in explaining the turn-of-the-year pattern. Return seasonality exists outside of January, with respect to the month of the quarter. Small stocks earn abnormally high average returns on the last day of each quarter, which significantly affects size, idiosyncratic volatility, and illiquidity portfolios. The results have implications for the interpretation and analysis of many anomalies, such as asset growth and momentum. The third chapter, titled ``The Cross-Section of Intraday and Overnight Returns,'' uses a thirty-year sample of U.S. stock returns to document substantial cross-sectional variation in returns over the trading day and overnight. Market closures have a large impact on returns. Small and illiquid stocks earn high average returns in the last thirty minutes of trading. In contrast, large and liquid stocks perform poorly at this time. I find support for institutional and information asymmetry theories. But these theories do not fully explain the cross-sectional evidence. Portfolios based on other characteristics, such as beta and idiosyncratic volatility, earn their return gradually throughout the trading dayâcontrary to the market and a benchmark based on random portfolios. These portfolios also tend to incur large negative returns overnight, consistent with mispricing at the open

Eosinophilic aseptic arachnoiditis: A neurological complication in HIV-negative drug-addicts

Abstract.: The finding of an eosinophilic aseptic meningitis in IV drug abuse is usually suggestive of an opportunistic infection or an allergic reaction. However, HIV-negative patients are at lower risk for developing these complications. Two young HIV-negative patients, with previous intravenous polytoxicomany, developed cystic arachnoiditis over the spinal cord associated with eosinophilic meningitis. Histology of the meningeal spinal cord lesions revealed a vasculocentric mixed inflammatory reaction. In one patient prednisone led to marked clinical improvement. Since infection, vasculitis, sarcoidosis and previous myelography were ruled out, we believe that the syndrome of eosinophilic aseptic arachnoiditis may be related to an hyperergic reaction in the meniges toward drug-adulterants inoculated through the intravenous rout