Abstract Objective To assess emotional processing and alexithymia in patients with restless legs syndrome (RLS) with augmentation versus those who never had augmentation. Methods We recruited 26 patients who had a history of augmentation (AUG), either current or past, 27 RLS patients treated with dopamine agonists who never had augmentation (RLS controls), and 21 healthy controls (HC). All participants were screened for impulse control disorders (ICDs). Alexithymia was assessed by means of the Toronto Alexithymia Scale – 20 (TAS‐20). Facial emotion recognition was tested through an eye‐tracking task. Furthermore, all participants performed neuropsychological tests assessing global cognitive status, impulsivity, anxiety, and depression. Results ICD symptoms occurred more frequently in AUG patients than in RLS controls (P = 0.047). Patients with AUG scored higher on the TAS‐20 (P = 0.007) and the attentional subdomain of an impulsivity scale (BIS‐11; P = 0.015) compared to HC. Patients with AUG also performed worse on the facial emotion recognition task relative to RLS controls (P = 0.009) and HC (P = 0.003). We found a group difference for the time to first fixation and the fixation count in the mouth region (P = 0.019 and P = 0.021, respectively). There were no other differences in the eye tracking examination. Interpretation This study showed evidence of poorer emotional processing in patients who had augmentation compared to RLS patients without augmentation and healthy controls. The altered exploration pattern of faces and the higher alexithymia scores suggest abnormalities in emotion processing in patients with augmentation.

Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are serious medical conditions that can result from compressed gas diving. DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata (CM). Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis (LR), and livedo racemosa (LRC) are used interchangeably but actually describe pathophysiologically different phenomena. CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a net-like, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC. Unlike in diving medicine, in clinical medicine/dermatology the pathology of livedo racemosa is well described as a thrombotic/embolic occlusion of arteries. This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism. Recent studies have shown a high correlation of cardiac right/left (R/L) shunts with arterial gas embolism and skin bends in divers with unexplained DCI. To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers. The R/L shunt screening results of 18 divers who suffered from an unexplained decompression illness (DCI) and presented with livedo racemosa were retrospectively analyzed. All of the divers were diagnosed with a R/L shunt, 83% with a cardiac shunt [patent foramen ovale (PFO)/atrium septum defect (ASD)], and 17% with a non-cardiac shunt. We therefore not only confirm this hypothesis but when using appropriate echocardiographic techniques even found a 100% match between skin lesions and R/L shunt. In conclusion, in diving medicine the term cutis marmorata/livedo reticularis is used incorrectly for describing the actual pathology of livedo racemosa. Moreover, this pathology could be a good explanation for the high correlation of livedo racemosa with cardiac and non-cardiac right/left shunts in divers without omission of decompression procedures.

The eye-tracking study aimed at assessing spatial biases in visual exploration in patients after acute right MCA (middle cerebral artery) stroke. Patients affected by unilateral neglect show less functional recovery and experience severe difficulties in everyday life. Thus, accurate diagnosis is essential, and specific treatment is required. Early assessment is of high importance as rehabilitative interventions are more effective when applied soon after stroke. Previous research has shown that deficits may be overlooked when classical paper-and-pencil tasks are used for diagnosis. Conversely, eye-tracking allows direct monitoring of visual exploration patterns. We hypothesized that the analysis of eye-tracking provides more sensitive measures for spatial exploration deficits after right middle cerebral artery stroke. Twenty-two patients with right MCA stroke (median 5 days after stroke) and 28 healthy controls were included. Lesions were confirmed by MRI/ CCT. Groups performed comparably in the Mini-Mental State Examination (patients and controls median 29) and in a screening of executive functions. Eleven patients scored at ceiling in neglect screening tasks, 11 showed minimal to severe signs of unilateral visual neglect. An overlap plot based on MRI and CCT imaging showed lesions in the temporo-parieto-frontal cortex, basal ganglia, and adjacent white matter tracts. Visual exploration was evaluated in two eye-tracking tasks, one assessing free visual exploration of photographs, the other visual search using symbols and letters. An index of fixation asymmetries proved to be a sensitive measure of spatial exploration deficits. Both patient groups showed a marked exploration bias to the right when looking at complex photographs. A single case analysis confirmed that also most of those patients who showed no neglect in screening tasks performed outside the range of controls in free exploration. The analysis of patients' scoring at ceiling in neglect screening tasks is of special interest, as possible deficits may be overlooked and thus remain untreated. Our findings are in line with other studies suggesting considerable limitations of laboratory screening procedures to fully appreciate the occurrence of neglect symptoms. Future investigations are needed to explore the predictive value of the eye-tracking index and its validity in everyday situations.

ABSTRACTBackgroundSeveral studies have reported an increased risk for patients with essential tremor to develop Parkinson's disease. In addition, hyperechogenicity in the area of the substantia nigra has been associated with a markedly increased risk for Parkinson's disease. The objective of this study was to evaluate the validity of substantia nigra hyperechogenicity in patients with essential tremor as a risk marker for Parkinson's disease.MethodsTranscranial sonography was performed in 70 patients suffering from essential tremor. Fifty‐four of these patients were available for follow‐up after a mean of 6.16 ± 2.05 years and were assessed for the incidence of new‐onset Parkinson's disease.ResultsThe relative risk for developing Parkinson's disease in patients with essential tremor who had hyperechogenicity at baseline versus those without this hyperechogenicity was 7.00 (95% confidence interval, 1.62–30.34; sensitivity, 77.8%; specificity, 75.6%).ConclusionsSubstantia nigra hyperechogenicity is also associated with an increased risk for Parkinson's disease in patients with essential tremor. These findings further support the potential role of this echofeature as a risk marker for Parkinson's disease. © 2016 Movement Disorder Society

Introduction Vasospasm still is a major cause of morbidity after aneurysmal subarachnoid hemorrhage. The purpose of this report is to describe the successful management of severe refractory vasospasm with continuous intra-arterial nimodipine (IAN) treatment. Case description A 72-year old right handed woman was admitted with non-traumatic SAH WFNS grade 1. Cerebral computed tomography demonstrated thick blood filling of the basal cisterns, and intraventricular hemorrhage. Cerebral angiogram failed to detect a vascular abnormality. After an uneventful initial course the patient developed symptomatic left middle cerebral artery vasospasm with aphasia and corresponding restriction in diffusion weighted images in the left frontal lobe. Bolus IAN only transiently improved cerebral circulation and clinical signs and symptoms. Continuous-IAN was started and led to full clinical recovery and normalisation of MRI diffusion restrictions. Discussion and conclusions Continuous selective intra-arterial infusion of nimodipine may be an option in selected patients with symptomatic vasospasm refractory to conventional treatment after careful consideration of benefits and procedure-related risks.

To evaluate the efficacy of ultrasound (US)-guided injections around the lateral femoral cutaneous nerve (LFCN) at different levels in meralgia paraesthetica (MP) patients.

BACKGROUND AND PURPOSE: Dual-energy CT features the opportunity to differentiate among up to 3 different materials because the absorption of x-rays depends on the applied tube voltage and the atomic number of the material. For example, it is possible to distinguish between blood-brain barrier disruption and an intracerebral hemorrhage following treatment for a stroke. The aim of this study was to evaluate whether dual-energy CT is capable of distinguishing intra-arterial contrast agent from residually clotted vessels immediately after endovascular stroke therapy. MATERIALS AND METHODS: Sixteen patients (9 women, 7 men; mean age, 63.6 ± 13.09 years) were examined. Measurements were made on the postinterventional dual-energy CT virtual noncontrast, iodine map, and "weighted" brain window (weighted dual-energy) series. Postinterventional conventional angiography was used as the criterion standard method. RESULTS: A residual clot was found in 10 patients. On the virtual noncontrast series, the Hounsfield attenuation of the clotted arteries was higher than that in the corresponding perfused contralateral arteries (53.72 ± 9.42 HU versus 41.64 ± 7.87 HU; P < .05). The latter had higher absorption values on the weighted dual-energy series than on the virtual noncontrast series (49.37 ± 7.44 HU versus 41.64 ± 7.87 HU; P < .05). The sensitivity for the detection of a residual clot was 90%; the specificity was 83.3%, and the accuracy was 87.5%. Interrater agreement was good (κ = 0.733). CONCLUSIONS: Dual-energy CT may be valuable in the detection of clot persistence or early re-thrombosis without the necessity of additional contrast administration. However, its relevance for the prediction of outcomes remains to be determined in further studies.

Poster: ECR 2015 / B-0549 / Detection of residual clots after endovascular stroke therapy with dual energy CT by: A. E. Grams, M. Knoflach, J. Willeit, M. Sojer, E. R. Gizewski, B. Glodny; Innsbruck/AT

To evaluate the accuracy of two different sonographic median nerve measurement calculations in predicting carpal tunnel syndrome (CTS) severity in a study population with clinically and electrophysiologically confirmed CTS.

Background: Accurate prediction of functional outcome in survivors of cardiac arrest (CA) is a major challenge. Up to now, data on the diagnostic accuracy of serum biomarkers are conflicting.

Objective: Selective amygdalohippocampectomy (AHE) has been associated with postoperative cerebral vasospasm (CVS) in patients with medically intractable temporal lobe epilepsy. The incidence in temporal lobe resection (TLR) is unknown. This retrospective cohort study evaluates the incidence of and risk factors for the development of CVS in patients with TLR and AHE. Methods: A total of 119 patients were included between 1998 and 2009. All patients were evaluated by standardized preoperative and postoperative transcranial Doppler sonography (TCD) evaluations and neurologic examinations. Postoperative CT scans were evaluated by an independent radiologist and the volume of bleeding within the resection cavity was quantified. Results: Of 107 patients with longitudinal TCD data, 35 (32.7%) developed postoperative CVS. The incidence of CVS did not differ between patients with TLR and AHE. CVS was associated with female gender and a higher bleeding volume in the postoperative CT scan (p = 0.035 and 0.046). Patients with CVS showed a significantly higher incidence of postoperative neurologic signs and symptoms (48.6%) compared to patients without CVS (25%, p = 0.015). The mean length of stay was significantly prolonged in patients with diffuse CVS compared to patients with localized CVS or no CVS (28.8 ± 10.9, 24.2 ± 6.6, and 18.2 ± 6.1 days, p < 0.001). Conclusion: CVS is a frequent complication of surgery for temporal lobe epilepsy irrespective of the resection method. Important risk factors for the development of postoperative CVS are female gender and a higher amount of bleeding in the postoperative CT. Patients with CVS more frequently have neurologic signs and symptoms resulting in prolonged hospital stay.

Vasospasm-related delayed cerebral ischemia (DCI) significantly impacts on outcome after aneurysmal subarachnoid hemorrhage (SAH). Erythropoietin (EPO) may reduce the severity of cerebral vasospasm and improve outcome, however, underlying mechanisms are incompletely understood. In this study, the authors aimed to investigate the effect of EPO on cerebral metabolism and brain tissue oxygen tension (PbtO2).

Movement DisordersVolume 27, Issue 2 p. 332-333 Letters: New Observations Substantia nigra hypoechogenicity in Friedreich ataxia†‡§ Heike Stockner MD, Heike Stockner MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorMartin Sojer MD, Martin Sojer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorSascha Hering MD, Sascha Hering MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorWolfgang Nachbauer MD, Wolfgang Nachbauer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorKlaus Seppi MD, Klaus Seppi MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorChristoph Schmidauer MD, Christoph Schmidauer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorWerner Poewe MD, Werner Poewe MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorSylvia M. Boesch MD, Corresponding Author Sylvia M. Boesch MD sylvia.boesch@i-med.ac.at Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaDepartment of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this author Heike Stockner MD, Heike Stockner MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorMartin Sojer MD, Martin Sojer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorSascha Hering MD, Sascha Hering MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorWolfgang Nachbauer MD, Wolfgang Nachbauer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorKlaus Seppi MD, Klaus Seppi MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorChristoph Schmidauer MD, Christoph Schmidauer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorWerner Poewe MD, Werner Poewe MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorSylvia M. Boesch MD, Corresponding Author Sylvia M. Boesch MD sylvia.boesch@i-med.ac.at Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaDepartment of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this author First published: 09 December 2011 https://doi.org/10.1002/mds.23989Citations: 3 † Relevant conflicts of interest/financial disclosures: Nothing to report. ‡ Full financial disclosures and author roles may be found in the online version of this article. § Note: During preparation and handling of our article, the group of Daniela Berg (Synofzik M, Godau J, Lindig T, Schöls L, Berg D. Transcranial sonography reveals cerebellar, nigral, and forebrain abnormalities in Friedreich's ataxia. Neurodegener Dis. 2011;8:470-475) published comparable data on TCS in FA patients. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume27, Issue2February 2012Pages 332-333 RelatedInformation

Movement DisordersVolume 27, Issue 9 p. 1196-1197 Letters: New Observations A follow-up study of substantia nigra echogenicity in healthy adults†‡ Philipp Mahlknecht MD, Philipp Mahlknecht MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorHeike Stockner MD, Heike Stockner MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorMichael Nocker MD, Michael Nocker MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorStefan Kiechl MD, Stefan Kiechl MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorJohann Willeit MD, Johann Willeit MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorChristoph Scherfler MD, Christoph Scherfler MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorMartin Sojer MD, Martin Sojer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorArno Gasperi MD, Arno Gasperi MD Department of Neurology, Hospital of Bruneck, Bruneck, ItalySearch for more papers by this authorGregorio Rungger MD, Gregorio Rungger MD Department of Neurology, Hospital of Bruneck, Bruneck, ItalySearch for more papers by this authorWerner Poewe MD, Werner Poewe MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorKlaus Seppi MD, Corresponding Author Klaus Seppi MD klaus.seppi@uki.at Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaDepartment of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this author Philipp Mahlknecht MD, Philipp Mahlknecht MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorHeike Stockner MD, Heike Stockner MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorMichael Nocker MD, Michael Nocker MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorStefan Kiechl MD, Stefan Kiechl MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorJohann Willeit MD, Johann Willeit MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorChristoph Scherfler MD, Christoph Scherfler MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorMartin Sojer MD, Martin Sojer MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorArno Gasperi MD, Arno Gasperi MD Department of Neurology, Hospital of Bruneck, Bruneck, ItalySearch for more papers by this authorGregorio Rungger MD, Gregorio Rungger MD Department of Neurology, Hospital of Bruneck, Bruneck, ItalySearch for more papers by this authorWerner Poewe MD, Werner Poewe MD Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this authorKlaus Seppi MD, Corresponding Author Klaus Seppi MD klaus.seppi@uki.at Department of Neurology, Medical University Innsbruck, Innsbruck, AustriaDepartment of Neurology, Medical University Innsbruck, Innsbruck, AustriaSearch for more papers by this author First published: 14 June 2012 https://doi.org/10.1002/mds.25080Citations: 17 † Relevant conflicts of interest/financial disclosures: : Philipp Mahlknecht holds a research grant from the Medical University of Innsbruck (IFTZ 2007152). ‡ Full financial disclosures and author roles may be found in the online version of this article. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume27, Issue9August 2012Pages 1196-1197 RelatedInformation

BACKGROUND:Aortic coarctation (AC) rarely remains undiagnosed until adulthood. Intracranial aneurysms and spontaneous subarachnoid hemorrhage (SAH) are more frequent in patients with AC than in the general population.METHODS:The purpose of this report is to describe the management of a poor grade SAH patient with previously undiagnosed AC using advanced monitoring techniques of the brain and the cardiovascular system.RESULTS:A 28-year-old man with previously unknown AC was admitted with aneurysmal SAH WFNS grade 5. Head computed tomography demonstrated thick blood filling the basal cisterns, mild hydrocephalus, and global cerebral edema. The ruptured aneurysm of the anterior communicating artery was successfully coiled on the same day. Echocardiography revealed high grade isthmus stenosis with a pressure gradient of 60 mm Hg. Hospital course was complicated by prerenal failure and severe vasospasm. Neuromonitoring data (cerebral metabolism, brain tissue oxygenation, cerebral blood flow and intracranial pressure) were used as endpoint to define the optimal blood pressure to meet the cerebral metabolic and oxygen demand in each phase.CONCLUSIONS:Cerebral aneurysm rupture associated with coarctation of the aorta is rare. The aim of this report is to call attention to AC in, particularly, young patients presenting with SAH and to discuss advanced multimodal neuromonitoring techniques used to optimize intensive care management.

Purpose: To evaluate the accuracy of ultrasonography (US) in the diagnosis of carpal tunnel syndrome (CTS) in patients with a bifid median nerve on the basis of cross-sectional area (CSA) measurements of the median nerve at the level of the carpal tunnel (CSAc), with additional measurements obtained more proximally (CSAp) at the level of the pronator quadratus muscle.Materials and Methods: This HIPAA-compliant study was approved by the local institutional review board; informed oral and written consent were obtained. Fifty-three wrists in 49 consecutive patients with a bifid median nerve and CTS symptoms and 28 wrists in 27 healthy volunteers with a bifid median nerve were examined by using US. Two independent US examiners who were blinded to prior test results measured median nerve CSA at two levels, CSAc and CSAp. The difference between CSAc and CSAp (D CSA) was calculated for each wrist. Receiver operating characteristic (ROC) analysis was performed.Results: The study population included 17 men and 32 women (mean age, 55.1 years; age range, 24-78 years). The control population included 13 men and 14 women (mean age, 52.6 years; age range, 24-86 years). Mean CSAc was approximately 5 mm 2 greater in patients with CTS than in healthy volunteers (P < .0001), while mean Delta CSA was 5.8-5.9 mm 2 greater in patients with CTS (P < .0001). A CSAc threshold of 12 mm 2 provided sensitivity and specificity of 84.9% and 46.5%, respectively, while a Delta CSA threshold of 4 mm 2 provided sensitivity and specificity of 92.5% and 94.6%, respectively. ROC analysis demonstrated a significant advantage of Delta CSA (area under ROC curve [A(z)] = 0.95-0.96) compared with CSAc (A(z) = 0.84-0.85) for the diagnosis of CTS (P < .003).Conclusion: The use of a Delta CSA parameter improves the diagnostic accuracy of US for the presence of CTS in patients with a bifid median nerve. (C) RSNA, 2011

Restless legs syndrome (RLS) is one of the most common neurological disorders. The diagnosis is mainly based on the patient's report of the characteristic symptoms and further on the response to dopaminergic treatment. In the past years, transcranial B-Mode sonography (TCS) of the mesencephalic brainstem has been introduced as a promising new method to assist the diagnostic approach to RLS. This review of literature describes the typical TCS findings in RLS including hypoechogenicity of the substantia nigra and raphe as well as hyperechogenicity of the red nucleus. The diagnostic parameters for patients with idiopathic and various forms of symptomatic RLS will be discussed as well as the current knowledge about the pathophysiology underlying these sonographical abnormalities.

BACKGROUND: Randomized controlled trials have yielded evidence for the efficacy and safety of intravenous alteplase in the therapy of acute ischemic stroke. A large patient registry has recently confirmed the safe implementation of this therapy in the clinical routine setting. METHODS: Between January 1998 and December 2007 302 stroke patients were treated with 0.9 mg/kg rt-PA at the stroke unit of the Innsbruck University Hospital. Severity and circumstances of the stroke event, indicators of pre- and intrahospital management as well as safety and outcome at three months were prospectively assessed in the local thrombolysis database. RESULTS: The number of patients receiving intravenous thrombolysis increased continuously from 2 patients in 1998 to 67 in 2007 and 87 patients in 2008. 43% of our patients were females. The median age and NIHSS-score on admission was 67 and 16, respectively. The mean onset-to-needle time decreased from 171 min to 110 min - mainly due to a substantial shortening of the door-to-needle time from 105 min to 45 min. A proportion of 41% of our patients were treated in the main working time while 59% received rt-PA during night and weekend service. A total of 38% of our patients were functionally independent at three months (mRS 0-2). Once considering the high initial stroke severity in our patient series and correcting the NIHSS scores to levels usually seen in randomized control trials and patient registries, 56% of our patients would reach a good outcome (mRS 0-2). The rate of symptomatic intracranial bleedings was low at 6.3%. CONCLUSION: Our data reinforce that intravenous thrombolysis is safe in the treatment of acute ischemic stroke in clinical routine setting. Establishment of modern stroke services and the implementation of structural operating procedures have contributed to an increase in the number of treated patients and a parallel decrease in door-to-needle time at our hospital. Widespread educational programs in the general community, introduction of optimized pre-hospital triage algorithms as well as the potential extension of the 3-hour window to 4.5 hours all are suitable measures to further extend the benefit of i.v. thrombolysis to large proportion of stroke patients.