Abstract Background Neuro-medical complications post-stroke are common and often serious [1]. We first described complications in our stroke cohort in 1998 and sought to assess whether the severity and the nature of neuro-medical complications may have changed over time due to changes in presentation and the processes of care [2]. Methods Analysis of stroke service database, which captures all neuro-medical complications as part of its portal for the Irish National Audit of Stroke (INAS), was completed. The frequency of each of the 19 complications was expressed as the percentage of patients that developed each complication over a certain year and over 5 years. Historical comparison was made with dataset from 1998, which captured six complications. Results Data on 1,283 patients presenting over 5 years between 2015–2019 was collected. The median age of all patients was 71 years (Range 21–101). In all, 19 different post-stroke complications were recorded; 48% (n = 622) had post-stroke pain, while 23.85% (n = 306) had cognitive decline. Data on 100 patients from 1998 was compared for a number of common metrics including; 21.82% (n = 275) of patients developed an LRTI in the 2015–2019 cohort compared with 14%(n = 14) in the 1998 cohort (p = 0.09) while 16.29% (n = 209) of patients developed a swallow disorder compared to 21% (n = 21) in 1998 (p = 0.22). Conclusion There are high levels of neuro-medical complications in stroke patients. Twenty years has seen extensive investment in hyperacute stroke care yet post-acute care complications did not appear to reduce significantly between this time, albeit with low numbers. Direction of future funding may consider the full spectrum of stroke care.

An autoimmune pathogeneses, at least in part, has been postulated for schizophrenia.Susceptibility to autoimmunity is strongly influenced by the genes clustered in the HLA region on chromosome 6, and linkage in a proportion of pedigrees has been reported in nearby markers.There is a negative association between schizophrenia and rheumatoid arthritis (RA), an autoimmune disease positively associated with HLA-DR4.Wright et al. (1996) postulated that there should therefore be a negative association between the DR4 allele and schizophrenia.In addition, a negative association between schizophrenia and DQB 1"0602 has been reported in American blacks (Nimgaonkar et al. 1993), and Chinese males (Zhang et al. 1994).We attempted to re-examine these findings in 229 familial schizophrenic probands and 248 unrelated controls at the DRB region, and 241 familial schizophrenic probands and 257 unrelated controls at the DQB region using the PCR-SSOP technique.The frequencies of DR4 in patients and controls was respectively 35.8 per cent vs. 35.8per cent, and the frequencies of DQBI*0602 in patients and controls was respectively 29.5 per cent vs. 27.6 per cent.These findings do not support the initial hypotheses.Some of the discrepancy may be due to study design in that the control frequencies in the Wright et al study were higher than in other samples from the region.It is also possible that the HLA association with schizophrenia is due to linkage disequilibrium with unidentified gene(s) within the HLA region which is less strong in the Irish population, particularly in the case of DQB 1"0602 as significant results were found.