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The clinical diagnosis of the type of acute cerebrovascular diseases is often considered unreliable, although this has not been validated prospectively in representative patients. The accuracy of bedside diagnostics was, therefore, tested in 206 patients consecutively admitted to the Stroke Unit of the Serafimerlasarettet in Stockholm. Bedside diagnosis turned out to be correct in 69%. In 24% the diagnoses were altered after hospital investigation and in the remaining 7% no defined preliminary and/or final diagnosis could be made. When the diagnoses were considered "fairly certain" they were accurate in 87%, compared to 53% when regarded as only "probable". The diagnostic accuracy improved during the period studied. Sensitivity in identifying hemorrhages was much lower (39%) than for cerebral infarctions (83%). It is suggested that new investigational methods should be compared with what can be accomplished with bedside methods alone.

In patients with acute ischemic stroke, dramatic but often transient improvements have been noticed after theophylline injections. Whether better results could be obtained by continuous infusion of the drug was evaluated in a double-blind study. Out of 46 patients with a mean age of 75 years, 22 got theophylline as aminophylline (bolus dose of 230 mg followed by 0.5 mg/kg/h) and 24 placebo during 3 days. The groups were comparable in all aspects at the outset of the trial. Serum theophylline concentrations were kept within the therapeutic range recommended for patients with asthma. No significant difference in outcome was noticed between the groups during the hospital period when repeated neurological assessments by two different scores and mortality were compared.

ABSTRACT. Cardiac disease is common in patients with cerebrovascular disease (CVD) and cerebral lesions as such may influence cardiac activity and rhythm. To study the indication for continuous ECG surveillance of patients with CVD, 100 consecutive patients admitted to a medical stroke unit were investigated with 24‐hour Holter recordings. The patients' mean age was 73 years and 70% of them had a history of heart disease. Twenty‐three patients had chronic atrial fibrillation and 55% of the remainder showed ventricular ectopic activity. Serious ventricular arrhythmias were comparatively rare and mainly seen in association with signs of congestive heart failure and acute myocardial infarction. A prolonged Q‐T interval was registered in two‐thirds of the patients but there was no significant association between this finding and ventricular ectopic activity. Close observation for cardiac complications is important in patients with CVD and continuous ECG surveillance is indicated in selected high‐risk patients.

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