Background and Purpose-In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS). MethodsA 1-year prospective, population-based study among the permanent residents of the canton Basle City, Switzerland, was performed using multiple overlapping sources of information. Results-Among 188 015 inhabitants, 269 patients had FEIS, of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100 000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients' age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help earlier than nonaphasic stroke patients. Still, after controlling for stroke onset-assessment interval, aphasic stroke patients were more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95% CI, 1.12 to 10.96). Conclusion-Annually, 43 of 100 000 inhabitants had aphasia resulting from first ischemic stroke. Advancing age and cardioembolism were associated with an increased risk for aphasia. Severity and fluency of aphasia were not affected by demographic variables.

Our study sought to estimate the incidence rate of first-ever ischemic stroke (FEIS) in the geographically well-defined population of the Canton Basle-City, Switzerland. An one-year prospective population-based study among the permanent residents of the Canton Basle-City (188015 inhabitants, census 2002) was carried out. Multiple overlapping sources of information were used. Stroke was defined according to the WHO criteria. The diagnosis of FEIS was based on clinical assessment and neuroimaging findings. 269 patients (114 males; mean age 72.8, standard deviation (SD) +/- 12 and 155 females; mean age 78.4, SD +/- 11) with FEIS were identified. The overall crude incidence of FEIS amounted to 143 per 100000 population (95% confidence interval (CI) 126 to 160) and it was higher among females (156; 95% CI 132 to 181) than in males (128; 95% CI 105 to 152). The age-specific incidence rates of FEIS approximately doubled with each decade of life, increasing from 17 (95 % CI 2 to 31) among 0-44 years old group to 1034 (95% CI 774 to 1293) for those aged 85 or more years. The overall incidence rate of FEIS adjusted for age to the European standard population was 76 per 100000 inhabitants (95% CI 66 to 86) and it was higher in males-89, 95% CI 72-106-than in females-66, 95 % CI 53-77. Moreover, in comparison with studies from other developed countries (e. g. Germany, Italy, Australia)-carried out in the middle of 1990s-the standardised incidence rates of FEIS were substantially lower in Switzerland. Our results indicate that the risk of ischemic stroke might be low in Switzerland. However, giving a major reduction in the age and gender specific stroke incidence over the past years our findings might-alternatively-mirror this favourable trend.

Objective: Barriers to thrombolysis are rather assessed for hospitalized stroke patients than among geographically defined populations. In a population-based approach, we assessed (1) the utilization rate of stroke thrombolysis in the community, and (2) the significance of the chosen stroke care provider as a potential barrier to thrombolysis. Methods: We performed a databank-based post hoc analysis, derived from data ascertained in a prospective, population-based stroke study among the permanent residents of the canton Basel-City, Switzerland. For the cohort with an onset assessment interval (OAI) ≤3 h, we compared thrombolyzed with nonthrombolyzed patients concerning demographic variables, the National Institutes of Health stroke scale (NIHSS) score, OAI, risk factors, and the type of stroke care provider. For patients without thrombolysis despite an OAI ≤3 h, barriers to thrombolysis were compiled. Results: Among 269 patients, 49 had an OAI ≤3 h (18% of all patients and 38% of those 128 patients with exactly known time of onset). Fourteen patients received thrombolysis, amounting to a utilization rate of 5.2% (95% CI 2.9–8.6) for all patients and 29% (95% CI 17–43) for the OAI ≤3-hour cohort. For the latter, thrombolyzed differed from nonthrombolyzed patients in higher NIHSS score and type of stroke care provider, but not in demographic variables, OAI, or risk factors. Fourteen of 40 patients (35%) primarily admitted to the stroke unit received thrombolysis, compared with none of 9 patients primarily treated elsewhere (p < 0.04). In the OAI ≤3-hour cohort, mild or regressing stroke severity (48%), admission to hospitals not offering thrombolysis (20%), computed tomography or laboratory contraindications (17%) and severe comorbidity (14%) were barriers to thrombolysis. Conclusion: In this geographically defined population, every 20th stroke patient received thrombolysis. Only a minority of patients had an OAI ≤3 h, rendering late admission the most common barrier to thrombolysis. In the OAI ≤3-hour cohort, admission to hospitals not offering thrombolysis prompted exclusion from thrombolysis as often as established contraindications. Thus, acute stroke patients should solely be brought to hospitals providing thrombolysis.

Objective: Data about the distribution of stroke severity and its correlates are sparse. In a population-based approach, we determined the NIH Stroke Scale Score (NIHSSS) and studied associations with demographic variables, stroke unit care, etiology, the onset assessment interval (OAI), and the rate of thrombolysis. Methods: We performed a databank-based post-hoc analysis of data ascertained during the prospective, population-based stroke study among the 188,015 permanent residents of Basel City, Switzerland. Results: In 246/269 (91.4%) patients, NIHSSS was available. The median NIHSSS was 5.0 ± 6.0. NIHSSS 0–6, 7–15, and >15 were present in 156 (63%), 56 (23%), and 34 (14%) patients. Higher NIHSSS were associated with advancing age (p = 0.038), female gender (p = 0.04), stroke unit treatment (p = 0.003), cardioembolism (p < 0.001), shorter OAI (p = 0.009), and thrombolytic therapy (p < 0.001). In multivariate regression analyses, age, OAI, and thrombolysis correlated independently with higher NIHSSS. Stroke unit patients differed from non-stroke unit patients in shorter OAI, younger age, and higher NIHSSS. Conclusion: In a geographically defined stroke population, 1/3 patients had moderate-to-severe stroke. Patients with less severe strokes were younger, sought medical attention later and were less likely to receive thrombolysis. Thus, public stroke awareness programs might consider targeting also younger individuals and stress that also mild-to-moderate strokes benefit from emergency medical care.