This article represents the update of ‘European Stroke Initiative Recommendations for Stroke Management’, first published in this Journal in 2000. The recommendations are endorsed by the 3 European societies which are represented in the European Stroke Initiative: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.

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Lymphedema is a common complication associated with cancer itself or with cancer treatment. Lymphedema infrequently occurs after drug therapy. Bee venom is one of the materials used in acupuncture, and it has been used in the treatment of a variety of inflammatory diseases including arthritis. We report a 74-year-old male patient with late-onset post-radiation lymphedema provoked by bee venom therapy. He was free of lymphedema for 5 years after the complete remission of prostate cancer which had been treated with transurethral resection and radiation therapy. The patient developed left leg swelling after undergoing bee venom therapy for left hip pain. Computed tomography and lymphoscintigraphy showed lymphedema without tumor recurrence or infection. The lymphatic system was suspected to be injured by bee venom therapy and lymphedema was provoked. Bee venom therapy should be used cautiously in patients prone to lymphedema.

Overuse of the nonparetic upper extremity can lead to entrapment neuropathies in chronic stroke patients. However, little is known about the effects of cane use in subacute stage of stroke. The aim of this study was to investigate the short-term effects of cane use on the upper extremity nerves in subacute stroke patients recovering from a bedridden state. Thirty subacute hemiparetic stroke patients who were initially bedridden participated when they were able to walk with a cane. Symptoms and signs related to the median or ulnar nerves were checked, and nerve conduction studies were performed. The largest cross-sectional area (CSA) of these nerves from the wrist to elbow was measured with ultrasound. After 3 weeks of cane use, electrophysiologic and ultrasonographic reevaluation was performed. Nerve conduction studies and CSA of the nerves at the nonparetic upper extremity showed significant changes, whereas those of the hemiparetic upper extremity did not. Walking with a cane for a short period can induce the enlargement of the median and ulnar nerves at the nonparetic extremity of subacute hemiparetic stroke patients. Attention should be placed on correct cane usage from the beginning of rehabilitation.