Objectifs : L'amelioration du pronostic des accidents vasculaires cerebraux par une hospitalisation precoce en unite specialisee, et les resultats de la thrombolyse dans les infarctus cerebraux, justifient cette analyse des diagnostics « d'accident vasculaire cerebral » aux urgences d'un Centre Hospitalier General. Methodes : Les dossiers codes « accident vasculaire cerebral » dans le registre informatique du service d'Accueil des Urgences pendant l'annee 1998, ont ete revus. Apres controle du diagnostic, l'etude a porte sur les caracteristiques demographiques, les facteurs de risque vasculaire, le delai d'admission, la duree du sejour hospitalier et le mode de sortie, pour le groupe des accidents vasculaires constitues. Resultats : Dans 24 % des cas, le diagnostic d'accident vasculaire cerebral propose par le medecin urgentiste a l'admission n'etait pas confirmee par le scanner ou le bilan hospitalier. Les accidents vasculaires constitues (a l'exclusion des hemorragies sous-arachnoidiennes) rassemblaient 218 patients, (âge moyen : 75,5 ans). Le delai d'admission etait inferieur ou egal a 2 heures dans 15,6 % des cas. La duree moyenne de sejour etait de 12,4 jours. Les accidents vasculaires cerebraux, constitues ou transitoires, ont represente 3 % de l'activite de medecine (8,7 des 287 lits theoriques) et 29 % de l'activite de neurologie du Centre Hospitalier. Conclusion : Les hospitalisations neuro-vasculaires representaient 3 % de l'activite medicale de notre Centre Hospitalier General. 1 patient sur 6 etait hospitalise dans les 2 heures suivant l'installation des symptomes.

CAROLE is a prospective survey of children and adults who experienced epileptic unprovoked seizure(s) diagnosed for the first time between May 1 1995 and June 30 1996 by 243 French neurologists and neuropediatricians. Case records forms at entry allowed to compare patients who had a single seizure or several seizures prior to diagnosis. In patients with recurrent seizures, the time elapsed between the onset of attacks and the diagnosis (diagnostic delay) was looked for.Half of the 1942 included individuals already experienced more than one seizure when diagnosed. Due to natural history of epilepsies, 13 p.100 of the patients did not come to medical attention after a single seizure. Time to diagnosis ranged from 0 day to 52 years. While the overall median delay was 6 days, it ranged from 0 day to 7-8 months according to the type of seizure and the epilepsy syndrome. Two thirds of generalized convulsive seizures were immediately diagnosed versus one third of partial seizures. One half of infantile spasms were identified within 2 weeks versus 6 weeks in complex partial seizures, 4 months in absence seizures, 6 months in simple partial seizures, and 7 months in myoclonic seizures. Three quarters of idiopathic partial epilepsies were diagnosed within 4 weeks versus 3 months in symptomatic generalized epilepsies, 8 months in symptomatic partial epilepsies, 15 months in idiopathic generalized epilepsies, 30 months in cryptogenic partial epilepsies, and 33 months in undetermined epilepsies.So, the time elapsed between a first epileptic event and its diagnosis is epilepsy-dependent seizure type and cause. Other reasons of diagnostic delay do exist: doctor and patient They will be addressed in another study.

Background In patients with acute ischemic stroke, early treatment with thrombolytic agents is thought to permit reperfusion of ischemic neurons and to promote recovery of function. The Multicenter Acute Stroke-Trial - Europe (MAST-E) was designed to assess the efficacy and safety of streptokinase in patients with acute ischemic stroke.Methods Patients with moderate-to-severe ischemia in the territory of the middle cerebral artery were randomly assigned to receive streptokinase (1.5 million units over a period of one hour) or placebo within six hours after the onset of stroke. The primary efficacy outcome was a binary criterion combining mortality and severe disability at six months, with severe disability defined as a score of 3 or higher on the Rankin scale. The primary safety outcomes were mortality at 10 days and cerebral hemorrhage.Results All randomized patients (156 in the streptokinase group and 154 in the placebo group) were evaluated at six months. The incidence of the primary efficacy outcome was similar in the two groups (124 patients in the streptokinase group and 126 in the placebo group died or had a Rankin score greater than or equal to 3). However, the mortality rate at 10 days was significantly higher in the streptokinase group than in the placebo group (34.0 percent vs. 18.2 percent, P=0.002). The higher rate in the streptokinase group was mainly due to the hemorrhagic transformation of ischemic cerebral infarcts. At six months, more deaths had occurred in the streptokinase group than in the placebo group (73 vs. 59, P=0.06).Conclusions In patients with acute ischemic stroke, treatment with streptokinase resulted in an increase in mortality. The routine use of streptokinase cannot be recommended in acute ischemic stroke. (C) 1996, Massachusetts Medical Society.

246 migraine patients (International Headache Society definition, 1-6 severe attacks per month) were randomised into a multicentre, cross-over study comparing subcutaneous (s.c.) sumatriptan 6 mg administered by an auto-injector (Glaxo device) with usual acute migraine treatments. Patients were treated for 2 months or up to 12 attacks, and then crossed over to the alternative treatment for the same duration. Usual treatments were: analgesics (including combinations), 49%; ergotamine, 24%; NSAIDs 19%; DHE, 7%. Rescue medication was allowed 2 h after the first dose. Headache was assessed on a 4-point self-rating scale (0: none, 1: mild, 2: moderate, 3: severe). Other migraine symptoms were assessed as present or absent. Quality of life was assessed before the study and at the end of each treatment period. Two hundred and seventeen patients were eligible for the cross-over analysis. At 2 h post-dosing, an average of 78% of attacks per patient were successfully relieved (grade 3 or 2 to 1 or 0) by s.c. sumatriptan, compared with 34% for the usual treatments (p < 0.001) and 63% of attacks per patient were completely relieved (grade 0) by s.c. sumatriptan compared with 15% for the usual treatments (p < 0.001). Sumatriptan-treated patients used rescue medication for 19% of their attacks, compared to 59% for comparator drugs (p = 0.001). Results for patient preference were: s.c. sumatriptan, 85%; usual treatments, 10%; no preference, 5% (p < 0.001). Sumatriptan was significantly superior to comparator drugs for all other efficacy end-points (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)