Jan van Gijn

..3 degrees C (95% CI: 0.1-0.5) in body temperature. We set out to test the hypothesis that early antipyretic therapy reduces the risk of death or dependency in patients with acute stroke, even if they are normothermic...

..Platelet aggregation can probably still occur despite complete acetylation of platelets, via pathways other than COX-1 inhibition, but in vitro aggregation tests are an unreliable measure...

..The growth of biomedical knowledge often leads to diseases being redefined. Diseases are not independent entities but human constructions...

..Compassion, curiosity and doubt are the essential forces that keep the cycle moving. Conversely, the progress is slowed down by present-day legalism, which distorts investigator accountability and patient autonomy...

..Once ischaemia has occurred, treatment regimens such as a combination of induced hypertension and hypervolaemia, or transluminal angioplasty, are plausible, but of unproven benefit...

..The injection of corticosteroids near the carpal tunnel is reasonably safe and also effective, albeit mostly just in the short term; in most patients the symptoms recur within a few months...

..In this study we compared risk factors, clinical features, and stroke recurrence in a large series of patients with large subcortical, cortical, or small deep infarcts...

..30; 95% CI 1.05-1.63) and death (aOR 1.51; 95% CI 1.15-1.98). An early rise in body temperature rather than high body temperature on admission is a risk factor for unfavorable outcome in patients with acute stroke...

..63 (95% CI 0.58 to 0.68)) and in ESPS 2 with female sex and absence of ischaemic lesions on imaging (area under the ROC curve 0.64 (95% CI 0.59 to 0.69))...

..We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for acute hydrocephalus...

..Hydrocephalus might cause gradual obtundation in the first few hours or days; it can be treated by lumbar puncture or ventricular drainage, dependent on the site of obstruction...

..Data on long term risks are scarce. We compared the long term risks of death and vascular events (VE) between these groups...

..76 to 1.85). CONCLUSIONS: Our data indicate that antiplatelet drugs reduce the risk of DCI in patients with subarachnoid hemorrhage. A randomized clinical trial is warranted to assess the effect on overall outcome...

..The benefit of repeated screening and the interval at which screening should be performed are unknown. We studied patient compliance and the yield of repeated screening for familial intracranial aneurysms...

..With precise rules, agreement in the classification of death after stroke strongly improved...

..Both her clinical condition improved and the lesions disappeared completely after withdrawal of tacrolimus, suggesting that her condition could be explained by a tacrolimus encephalopathy...

..Therefore, the planned primary analysis of the PAIS study has been changed from fixed dichotomization of the mRS to a sliding dichotomy analysis...

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..CONCLUSIONS: Most studies on treatment strategies in SAH suffer from methodological weaknesses. This implies that current management of patients with SAH is based on weak evidence...

..The authors assessed the magnitude of the reduction in poor outcomes that accompanies a strategy aimed at surgery...

..The aim of this study was to gain insight into the prevalence, cause, and outcome of VSR in patients with symptomatic CAO...

..The need for measuring comorbidity with regard to functional status is recommended in research on stroke outcome...

..Such assessment may prevent unnecessary risk with oral anticoagulation in secondary prevention after cerebral ischaemia of arterial origin, of which the efficacy is currently being assessed in ESPRIT...

..Little information is available on the type of subsequent ischaemic strokes that may occur (anterior or posterior circulation and small vessel or large vessel)...

..To investigate the relation of endothelial cell activation with delayed cerebral ischaemia (DCI) and outcome after subarachnoid haemorrhage (SAH)...

..To compare the diagnostic accuracy of visual inspection and spectrophotometry for identifying the presence of bilirubin in the cerebrospinal fluid (CSF)...

..We investigated determinants of non-adherence in patients who used aspirin or oral anticoagulation after cerebral ischaemia of arterial origin...

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..Types of treatment varied according to the current opinion on its causes. In most patients the best results are obtained through drug treatment; for a few, surgery is necessary...

..Treatment with interferon beta-Ia in high-risk patients also slows down the progression to clinically definite MS, but the long-term benefits are uncertain. MR imaging of the brain has implications for prognosis but not for treatment...

..We aimed to assess whether magnesium reduces the frequency of delayed cerebral ischemia (DCI) in patients with aneurysmal SAH...

..Subdivisions according to the center of hemorrhage once the anterior cisterns are involved is not helpful in identifying patients with good or poor outcome...

..The authors compared the size of ruptured aneurysms and the number of aneurysms between patients with familial subarachnoid hemorrhage (SAH) and those with sporadic SAH...

..In familial intracranial aneurysms there is evidence for genetic heterogeneity, probably from mutations at separate loci...

..To assess whether the case-fatality rate has improved after the introduction of new management strategies, we studied outcome in all population-based studies from 1960 onward...

..To identify hemodynamic factors that predict recurrence of ipsilateral cerebral ischemic events in patients with symptomatic carotid artery occlusion (CAO)...

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..We sought to assess whether MRI, MR angiography, or (1)H MR spectroscopy can be used to identify patients with symptomatic carotid artery occlusion (CAO) who are at high risk of recurrent ipsilateral cerebral ischemic events...

..We used decision analysis to compare possible diagnostic strategies in these patients...

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..In our series, one per 70 patients with SAH presents with ACS. Keys to early diagnosis of SAH in patients presenting with ACS are a preceding period of loss of consciousness and severe headache on neurological assessment...

..An alternative explanation is recall bias. The clinical and radiological features of patients with SAH were studied in relation to previous headaches or later rebleeding...

..They refer only three-quarters of patients with probable ITMB to a specialist and start antithrombotic medication in only one-third of these patients. Therefore further education with regard to transient monocular blindness is needed...

..Thus, although no episodes of SAH occurred after ITH during long-term follow-up, one-half of patients with ITH had a lower level of daily functioning, and one-eighth had reduced working capacity, specifically because of headache...

..We studied the prognostic value for DCI of 2 factors: the duration of unconsciousness after the hemorrhage and the presence of risk factors for atherosclerosis...

..Myotatic reflexes may therefore be useful for the distinction between axonal and demyelinating polyneuropathy...

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..We assessed functional outcome and quality of life (QoL) in patients with SAH and their partners...

..We conducted a systematic review on prevalence and risk of rupture of intracranial aneurysms and classified the data according to study design, study population, and aneurysm characteristics...

..All showed depression of the eyebrow on the affected side. The clinical course varied: in two patients the symptom resolved spontaneously after positive reassurance; in the third patient it remained unchanged for 2 years...

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..This evidence is found in both clinical features and ancillary investigations, particularly measurements of cerebral blood flow...

..Infarct volume is increasingly used as an outcome measure in clinical trials of therapies for acute ischemic stroke. We tested which of 5 different methods to measure infarct size or volume on CT scans has the highest reproducibility...

..Possibly, this activation represents the influence of vascular factors on the cerebral endothelium as a prelude to increasingly severe small vessel disease...

..If the cause is insufficiently, the presence of brain death should be seriously doubted, unless an isoelectric EEG is observed...

..These effects were reduced to nonsignificant trends after adjustment for imbalances in baseline characteristics. In conclusion, early treatment of patients with tirilazad has no effect on infarct volume...

..Prospective studies are needed to confirm causality and to study the efficacy of treatment of vascular risk factors...

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..To assess whether patients with carotid artery occlusion (CAO) who have clinical features suggesting a haemodynamic origin have a poor haemodynamic or metabolic state of the brain...

..In addition, we investigated the effect of treatment with aspirin or oral anticoagulation on recurrent stroke rate and assessed whether the incidence of recurrent stroke has decreased over the years...

..Physicians still speculate more often than they care to admit...

..The second issue is the variability and overlap of terms used to describe each phenomenon. This makes comparisons among studies difficult...

..To determine the test characteristics of magnetic resonance (MR) angiography in the assessment of occlusion of aneurysms treated with coil placement...

..Our study was designed to describe the mental status and health-related quality of life (HRQoL) in long-term survivors of TIA or minor ischaemic stroke (MIS) and evaluate associations of mental and physical factors with HR-QoL...

..In a phase II randomized clinical trial of 283 patients, magnesium treatment reduced the risk of DCI by 34% and of poor outcome by 23%...

..Patients will continue to seek magic cures from 'quacks with a knife' as long as medical specialists are insufficiently trained to deal with unexplained somatic symptoms...

..Predictive factors for risk of vascular events were similar to those for risk of death. INTERPRETATION: Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement...

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..Ideally, evidence on this issue should come from a randomised clinical trial. However, such a trial or even a prospective study are unlikely to be ever performed because of the rapid development of endovascular coiling...

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..We analyzed the relationships of concentrations to initial clinical conditions, treatment modalities, and the occurrence of delayed cerebral ischemia...

..We therefore studied the accuracy and the inter- observer agreement in the classification of dysarthrias on the basis of perceptual analysis alone...

..In any middle aged male patient with ascending motor or sensory deficits in the legs, SDAVF should be considered in order to prevent irreversible handicap...

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..The diagnosis should be strongly suspected if the patient is a young woman, if the lesion is within the basal ganglia or thalamus, and especially if it is bilateral...

..Oddly enough some regard this as an advantage. In general it is a shoddy substitute because teaching is an art, because students cherish proper explanations and because the students are deprived of...

..However, anatomical studies indicate that in some people the supply of the posterior cerebral artery is via the carotid system. We investigated how often such a developmental variant in the cerebral blood supply was present during life...

..After a 1996 review from our group on risk factors for subarachnoid hemorrhage (SAH), much new information has become available. This article provides an updated overview of risk factors for SAH...

..The epsilon4 allele of the apolipoprotein E gene (apoE) may be a candidate because this allele is associated with both the vascular risk factors and the consequences (cognitive impairment, dementia) of WMLs...

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..Fibrinogen is an independent risk factor for coronary events in population-based studies and in patients with coronary heart disease, but there is uncertainty about prediction of stroke, particularly in secondary prevention...