Fever in the first 7 days was an independent predictor of poor outcome during the first month after a stroke. No data were available on the underlying causes of fever, but the higher risk of death in the first 10 days, most frequently attributed to neurological mechanisms, suggested that high temperature was an independent component of poor prognosis and not only an epiphenomenon of other complications in the course after a stroke. In agreement with animal studies, we found that patients with higher temperature had a worse stroke outcome.

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The role of education and psychosocial environment as factors for the development of dementia is controversial. We carried out a comparative study on the prevalence of dementia among persons over 74 years of age in two Sicilian municipalities, Troina and S. Agata Militello, with different psychosocial backgrounds. A two-stage survey was performed for both samples. In stage 1 the Mini Mental Status Examination (previously validated for the cutoff score with 100% sensitivity and the highest specificity) was used to screen a 50% random sample of persons over 74 years of age. In those referred to stage 2, the diagnosis of dementia was made by a neurologist according to DSM-III R. Three hundred and sixty-five subjects were recruited in Troina and 408 in S. Agata Militello. The minimal estimates of dementia prevalence were 21.9% (21.9% men, 21.9% women) in Troina and 28.4% (26.6% men, 29.6% women) in S. Agata Militello. Although intrasample multiple logistic exact analysis (demented vs. unproven demented) indicated poor formal education and manual occupation as risk factors for dementia, and intersample comparison (Troina vs. S. Agata Militello) showed that these variables were more frequent in Troina, we did not find a higher prevalence of dementia in this community. We discuss this apparently ambiguous result and suggest that psychosocial and cultural variables might be considered multiple interacting factors with different protective or predisposing roles for dementia. Higher or lower risk could then be the result of this complex interaction in different populations.

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Patients with milder symptoms, for whom treatment might be more effective, were less likely to arrive in time for therapy. The proposed model of the relationship between the delay in hospital presentation after a stroke and the clinical efficiency of a given treatment might be useful for planning future clinical trials on early stroke treatment and predicting the impact of an educational program aimed at shortening arrival time.

Background and PurposeThe incidence of stroke among inpatients is not known. The aim of our study was to investigate the incidence of stroke not preceded by evident iatrogenic factors such as surgical or medical procedures in a cohort of inpatients in a large Italian general hospital.Methods From January 1, 1992, to December 31, 1992, we evaluated patients referred to our neurology department with a suspected diagnosis of stroke that occurred during hospitalization. Patients presenting with stroke as a complication of iatrogenic causes were excluded. We calculated the incidence rate of first-ever stroke in our cohort (crude and among patients aged older than 50 years), thereafter adjusting these rates for age to the general population of the city district of Bologna (Italy).

Multiple sclerosis (MS) usually starts in young adulthood. However, the disease may appear late or very late in life. We report 6 cases with onset after the age of 59 years and review the literature. As in early onset disease, the diagnosis is mainly clinical. Laboratory findings and paraclinical evidence may support the diagnosis if clinical data are not sufficient. In elderly patients clinical history and laboratory data should be thoroughly appraised to exclude conditions more common in old age such as vascular diseases.

Objective-To determine whether a multisystemic bioenergetic deficit is an underlying feature of familial hypobetalipoproteinaemia. Methods-Brain and skeletal muscle bioenergetics were studied by in vivo phosphorus MR spectroscopy (31P-MRS) in two neurologically affected members (mother and son) and in one asymptomatic member (daughter) of a kindred with familial hypobetalipoproteinaemia. Plasma concentrations of vitamin E and coenzyme Q,0 (CoQ,0) were also assessed.Results-Brain 31P-MRS disclosed in all patients a reduced phosphocreatine (PCr) concentration whereas the calculated ADP concentration was increased. Brain phosphorylation potential was reduced in the members by about 40%. Skeletal muscle was studied at rest in the three members and during aerobic exercise and recovery in the son and daughter. Only the mother showed an impaired mitochondrial function at rest. Both son and daughter showed an increased end exercise ADP concentration whereas the rates of postexercise recovery of PCr and ADP were slow in the daughter. The rate of inorganic phosphate recovery was reduced in both cases. Plasma concentration of vitamin E and CoQ,, was below the normal range in all members. Conclusions-Structural changes in mitochondrial membranes and deficit of vitamin E together with reduced availability of CoQ,0 can be responsible for the multisystemic bioenergetic deficit. Present findings suggest that CoQ,0 supplementation may be important in familial hypobetalipoproteinaemia. (7 Neurol Neurosurg Psychiatry 1997;62:574-580) The pathogenesis of this disorder is not yet fully understood. However, neurological symptoms and signs and the underlying neuropathological changes have been related to altered composition of cellular membranes due to the deficit of lipoprotein and vitamin E found in these patients34 and to the inability of the liver to incorporate vitamin E in the very low density lipoprotein and in LDL.5 A deficit of vitamin E leads to an excessive lipid peroxidation with production of lipid peroxyl radicals which in turn can result in damage to cell membranes36 as well as proteins and DNA.78 Therefore, it is conceivable that by different mechanisms, the damage due to free radicals results in an impairment of mitochondrial functionality and ATP production.9 12 Tissue bioenergetics can be assessed in vivo by phosphorus magnetic resonance spectroscopy (31P-MRS), the only available noninvasive method that gives precise information on the efficiency of ATP production and the extent to which oxidative metabolism meets the bioenergetic needs of cell function.The aim of this study was to investigate by in vivo 31P-MRS whether a multisystemic defect of tissue bioenergetics is an underlying feature of the neurological disorders found in patients with a deficit of APO-B.In view of the antioxidant role of vitamin E and the bioenergetic and antioxidant functions of CoQ,0,7 13 we also assessed the plasma concentrations of vitamin E and CoQ,0.Patients and methods PATIENTS AND LABORATORY DATA Figure 1 shows the famil...