Background and Purpose: Studies on post-stroke seizures have produced conflicting results. Our study aim was to further elucidate the incidence and predictive factors of early post-stroke seizures (ES) and their relationship with outcome. Methods: relevant clinical data were prospectively collected in 2,053 patients with acute stroke admitted to the Stroke Unit from 2004 to 2008. Results: Sixty-six patients (8 hemorrhagic and 58 ischemic strokes) aged 73–88 years (mean age 82 years) presented seizures in the first week after stroke onset. The type of ischemic stroke was atherothrombotic in 10 patients, cardioembolic in 21, lacunar in 4, undetermined in 19, and of other etiology in 4. Twenty-seven patients had generalized convulsive, 6 had complex partial, and 33 had simple partial seizures. Status epilepticus was observed in 13 patients. The severity of strokes in patients with ES was greater than in those without (National Institutes of Health Stroke Scale >14 in 50 vs. 25%), so mortality (30 days) was higher (29 vs. 14%). Independent seizure predictors were: total anterior circulation infarct, hemorrhagic transformation, hyperglycemia, and the interaction term diabetes × hyperglycemia. Conclusions: ES may be considered a marker of stroke severity. Cortical location of the lesion, hemorrhagic transformation, and hyperglycemia in patients without diabetes are important predictors of ES.

SYNOPSIS Nine patients with migraine (5 with migraineous stroke) were investigated for defects of mitochondrial energy metabolism. During effort, blood lactate rose significantly higher in migraineurs. Muscle biopsy showed ragged‐red fibres deficient in cytochrome‐c‐oxidase activity in one case. On muscle biochemistry, depression of some respiratory chain enzymes was found for the whole group of patients, and especially in 2 for cytochrome‐c‐oxidase, succinate‐cytochrome‐c‐reductase and NADH‐cytochrome‐c‐reductase. Our findings are still preliminary, but they suggest impaired mitochondrial energy metabolism in migraine.

The brain and skeletal muscle of eight adult patients with migraine with prolonged auras or migraine strokes leaving a permanent hemianopic defect were studied by phosphorus magnetic resonance spectroscopy. Biochemical assays performed on muscle biopsy and platelets had revealed abnormal mitochondrial enzyme activities. Brain magnetic resonance spectroscopy showed an abnormally low phosphocreatine to inorganic phosphate ratio in all patients, apparently due to decreased phosphocreatine and increased inorganic phosphate contents. Muscle phosphorus magnetic resonance spectroscopy showed low recovery from exercise in seven patients. Three patients had an increased phosphocreatine/inorganic phosphate ratio at rest, and the exercise transfer characteristics were abnormal in four patients for relatively low levels of exercise. The mitochondrial metabolic defects present in platelets and muscle of complicated migraine patients are therefore also expressed in the brain.

The brain and skeletal muscle oxidative metabolism of a patient with prolonged aura was studied by phosphorus magnetic resonance spectroscopy. We found that the phosphocreatine to ATP ratio in brain was reduced, while the inorganic phosphate to phosphocreatine ratio and the calculated ADP concentration were increased. The phosphorylation potential and percentage of maximal rate of ATP synthesis were also altered. Intracellular pH and inorganic phosphate concentration were normal. In muscle we found a low post-exercise recovery of phosphocreatine. These data indicate an impairment of energy oxidative metabolism both in brain and muscle.

SUMMARY An epidemiological survey on headache was performed in the Republic of San Marino, which is the smallest independent State in the world, located near the Adriatic Coast, within Italy. Among a random sample of 1500 inhabitants over 7 years of age the frequency of headache, severe headache and migraine in the previous year was 35 3%, 12-2%, 9-3% respectively for men, and 46-2%, 20-6%, 18% for women. The most common factors reported to provoke headache were emotional stress, physical strain, lack of sleep, particular foods or drinks and for women menstruation. Migraine patients differed from people without headache in that they had a higher consumption of coffee, more frequently reported bad sleep, allergic disease and previous appendectomy. Furthermore, migraine patients and severe headache sufferers had a higher diastolic blood pressure than non headache subjects. The first three parts concerned general demographic findings, life habits and past medical history. The first question of the fourth part was: "Do you suffer or have you suffered over the past year from headache?" In the case of an affirmative answer the questionnaire was completed. Otherwise people were asked if they had suffered from headache in the past and if such headache was frequent or rare, at which age it had begun and ended and the questionnaire was stopped. Blood pressure was taken with a standard mercury manometer on the right arm, with the subject sitting, at the end of the third part of the questionnaire and before the first question of the fourth part. Interviewers were trained at the Headache Centre of our Clinic where they interviewed together 50 patients with headache under the supervision of a physician expert on headache. Subsequently they did 80 cross-interviews to volunteer inhabitants of San Marino encountered in government offices and 20 children in primary and junior schools. Agreement between the two interviewers ranged from 76% to 100% depending on single items. Agreement between the two interviewers on the major questions is shown in table 1. Among people who answered the questionnaire a random sample of 80 suffering from headache were invited to come forward to be interviewed and examined by a neurologist expert on headache. Sixtyone of them agreed to be examined. All 42 people who answered affirmatively to question No 65 were also interviewed (personally or by telephone) by two of us in order to ascertain classic migraine cases.Among 346 people who refused to answer the questionnaire we interviewed 169 (84 men, 85 women) of them by telephone, asking if they suffered from headache and its severity. Distribution by age and sex of the whole popu-21

Characteristics related to neurologic impairment on admission were the main predictors of acute outcomes of IS in this cohort. Specific IS etiology and subtype influenced IS outcomes only after age 80. In oldest-old patients, demographics and prestroke functional and health status also influenced IS outcomes with peculiar associations.

The heterogeneity of published data regarding post-stroke depression (PSD) prompted an Italian multicenter observational study (DESTRO), which took place in 2000-2003. The investigation involved 53 Italian neurology centers: of these, 50 treat acute patients and 3 provide rehabilitation care; 21 centres are in Northern Italy, 20 are in Central Italy, and 12 are in Southern Italy. The time schedule was articulated into three phases: registration of 6289 stroke patients; selection of 1817 cases and enrollment of 1074 patients; and follow-up for two years (1064 patients). Mood assessment was performed by evaluating depressive symptoms according to DSM IV and the Beck depression inventory (visual analog mood scale for aphasic patients). Depressed patients were also administered the Montgomery-Asberg depression rating scale. Scores were related to function (Barthel index, modified Rankin scale), cognition (MMSE), quality of life (SF-36), and clinical data. Data analysis will provide information on PSD prevalence, onset and evolution, correlation with ischemic clinical syndrome, impact on activities of daily living, cognitive level and quality of life. The few data available at the present time concern PSD prevalence in the first six months after stroke (33.6%). DESTRO is a longitudinal investigation of a large patient sample and is expected to provide insights into the relationship of PDS with the functional and clinical consequences of stroke.

The aim of this double-blind crossover study was to compare the prophylactic effect of acetylsalicylic acid (ASA) with that of propranolol (PRP) in the treatment of migraine. Plasma concentrations of the two drugs were measured in order to investigate a possible relationship to the clinical effect. Compared to the pretreatment period, PRP and ASA reduced migraine index, frequency, duration, severity of attacks and headache days. Due to the limited number of patients, our results should be cautiously interpreted, however relevant the clinical improvement seemed. Improvement of migraine index was not related to different plasma levels of the two drugs.