Background and Purpose-Although the cause of stroke among patients with patent foramen ovale (PFO) may be due to paradoxical cerebral embolism (PCE), this mechanism is often difficult to prove. The aim of our study was to evaluate the association between brain imaging findings suggestive of embolism and PFO among ischemic stroke patients.

Concepts for stroke units that cover the acute phase vary. Therefore, the network of acute stroke units that is being set up in Austria in a uniform way is of general interest. This nationwide network has been established in accordance to evidence-based recommendations and prespecified criteria for available resources. The location for such a unit follows a maximum of 90-min isochrones (transport time) to the hospital. The quality of the network is currently documented and the results are reported. A nationwide stroke registry was prospectively performed on 15 stroke units that were already functional in this network. The aim was to document the quality performance of Austrian stroke units, focusing on rapid admissions, ready availability of investigations and therapies performed. Outcome measures were Barthel scale, Rankin score and percentages of complications. Between August 1998 and December 2000, 2,313 patients with ischemic stroke or with primary intracerebral hemorrhage admitted to an Austrian stroke unit within 24 h after onset of symptoms were prospectively included. Forty-three percent of the patients had a moderate or severe stroke. Fifty-seven percent of all patients were admitted to the stroke unit within 3 h after the onset of symptoms. Twenty-seven percent of these patients were brought in by ambulance accompanied by an emergency physician. Two percent of patients were admitted by helicopter. Fifty-four percent of patients had their first brain imaging within 30 min after admission, another 26% within 3 h. Intravenous thrombolysis was performed in 4.1% of patients. The overall stroke-unit mortality was about 6.8% and mortality at 3 months was 12.9%. The outcome at 3 months showed a modified Rankin Scale score of 0 or 1 in 47% of patients, denoting none or mild impairment. This network of acute stroke units is highly efficient in terms of rapid admissions, short intrahospital delays, as well as rapid use of readily available investigations. Stroke units seem to be well accepted by the general public and the medical community because our data show that all types of strokes are treated in Austrian stroke units, including severe strokes. The total number of concurrently treated acute strokes in other institutions across Austria is not known and no formal comparison with other systems of hospitalized care was undertaken, therefore further research is necessary.

A system of acute stroke units is being set up in Austria, which will care for 70% of all acute strokes by 2005. This nationwide project has been planned according to evidence-based principles and contains pre-specified structural components for acute stroke care. With some exceptions in remote mountain regions, all stroke units can be reached within 90 min from any community. All units are within neurological departments. An ongoing documentation of quality performance shows that these units are being well accepted by the general population and the medical community alike.

Over a period of 3 years, neither history of TIA nor evidence of silent infarct diagnosed at the time of the presenting major stroke in first-ever ischemic stroke patients exert an important influence on neurological or epidemiological outcome variables.

In spite of the decrease in stroke mortality in industrialized western countries an increase of stroke incidence is expected especially in developing countries. Thus, within the next years, stroke will lead to a growing global health burden. In Austria, mortality has decreased between 1970 and 1994 by half and has now reached a rate of 100 per 100,000 inhabitants per year. Incidence rates amount to 200-300 per 100,000 inhabitants per year. Recurrent stroke rates are estimated to occur at a rate of 6-12% within the first year and 5-8% within the following years. Data from the Austrian Stroke Unit Registry comprise data compiled in 15 stroke units and show that the 3 month mortality is 11.7% and 40% show pronounced or moderate residual disabilities.

No abstract

No abstract