The aim of this study was to determine the number of annual hospitalizations and overall episodes of care that involve a traumatic brain injury (TBI) by age and gender in the province of Ontario. To provide a more accurate assessment of the prevalence of TBI, episodes of care included visits to the emergency department (ED), as well as admissions to hospital. Mechanisms of injury for overall episodes were also investigated.

Traumatic brain injury cases from fiscal years 2002/03-2006/07 were identified by means of ICD-10 codes. Data were collected from the National Ambulatory Care Reporting System and the Discharge Abstract Database.

The rate of hospitalization was highest for elderly persons over 75 years-of-age. Males generally had higher rates for both hospitalizations and episodes of care than did females. The inclusion of ED visits to hospitalizations had the greatest impact on the rates of TBI in the youngest age groups. Episodes of care for TBI were greatest in youth under the age of 14 and elderly over the age of 85. Falls (41.6%) and being struck by or against an object (31.1%) were the most frequent causes for a TBI.

The study provides estimates for TBI from the only Canadian province that has systematically captured ED visits in a national registry. It shows the importance of tracking ED visits, in addition to hospitalizations, to capture the burden of TBI on the health care system. Prevention strategies should include information on ED visits, particularly for those at younger ages.

Some studies have suggested an association between hypocholesterolemia and intracerebral hemorrhage (ICH). In the SPARCL trial, statin use increased ICH risk. We tested the hypothesis that use of statins affects the volume of spontaneous ICH and contributes to the progression of ICH volume between baseline and follow-up CT scans.

Consecutive cases of spontaneous ICH were reviewed. Secondary causes were excluded. We measured ICH volume on the baseline and follow-up CT scans using the AxBxC/2 method. Multivariate analysis and logistic regression modeling were used. The primary outcome was the ICH volume on the baseline CT scan. Secondary outcomes included volume variation between the baseline and the first follow up CT scans and death.

Of 303 subjects, 71 were taking a statin at the time of the ICH (23%). Statin users were significantly more likely to be younger, to have co-morbidities and take anticoagulant or anti-platelet medication. They also had a higher baseline ICH volume than non-statin users (median 31.2 [10,82.1] ml vs 16 [4,43.8] ml; p=0.006). Adjusting for possible confounders, statins remained associated with an increased ICH volume (p=0.007). There was a significant mean ICH volume progression between the first and second CT scans in statin users (+10.8 vs +0.9 ml; p=0.03; 95% CI: [-1,+22.6] [-2.5,+4.3]). No difference in mortality was seen between the two groups.

Treatment with HMG-CoA reductase inhibitors may be a risk factor for increased ICH volume in spontaneous brain hemorrhages and could contribute to hemorrhage's volume progression.

Statins have been shown to increase endothelial progenitor cells (EPCs) in patients with cardiovascular disease. However, there is no similar study that has been done on the patients recovering from cerebrovascular disease. We present the largest prospective study of statin therapy on EPC levels of patients recovering from stroke.

Our study subjects were treated with rosuvastatin (10 mg/day) over a period of 12 weeks. Blood was collected from these patients periodically and EPC levels were measured along with other biochemical parameters.

Our study shows that rosuvastatin treatment significantly reduces the low density lipoprotein (LDL) levels in the patients over the 12 weeks. However, we did not find any corresponding changes in the EPC levels during this time period. Earlier reports indicated that statin use could increase EPC proliferation. Our research, however, indicates that the in-vivo effects of rosuvastatin are not similar to those of previous reports. There may be several reasons for this lack of congruence between these two studies, including age of the study population, predominantly low high density lipoprotein (HDL) levels in our subjects and effects from other concomitant medications.

Inflammation plays a pivotal role in the pathogenesis of atherosclerosis and of cerebrovascular complications. Transforming growth factor-β (TGF-β) is a pleiotropic cytokine with a central role in inflammation. To investigate whether polymorphisms of the TGF-β1 gene can modify the risk of ischemic stroke (IS) in Chinese population, we conduct this hospital-based, case-control study.

Transforming growth factor-β1 genotype was determined in 450 Chinese patients (306 male and 144 female) with IS and 450 control subjects (326 male and 124 female).

Subjects carrying 869TT were susceptible to IS (odds ratio [OR] =1.58; P=0.003). Further analysis of IS data partitioned by gender revealed the female-specific association with 869T/C (OR=2.64; P=0.001).

Findings suggest that the TT genotype of 869T/C might be a risk factor of IS in Chinese, especially in females.

Thrombolysis in acute ischemic stroke is usually performed in comprehensive stroke centres. Lack of stroke expertise in remote small hospitals may preclude thrombolysis. Telemedicine allows such management opportunities in distant hospitals.

We report our experience in managing acute stroke over a two-year time period with telestroke. The University of Alberta Hospital acted as the ‘hub’ and seven remote hospitals as ‘spoke’. The neurologist at the ‘hub’ provided stroke expertise to the local physician using either a two-way video link or telephone. Cranial CT scans were transmitted to ‘hub’. Education sessions were held before the initiation of the program.

Of 210 patients 44 (21%) received thrombolysis at the ‘spoke’ sites. In 34/44 (77%) two-way video link was available while in 10/44 (23%) telephone was used. Five (11.4%) patients experienced intracranial hemorrhage after thrombolysis, 2 (4.5%) were symptomatic. Favorable (mRS=0-1) outcome at three months was 16/40 (40%) and mortality was 9/40 (22.5%). Four patients were lost to follow-up. There was no significant three months outcome difference between two-way video link and telephone consultation (P = 0.689). Over two years the number of acute stroke transfers decreased from 144 to 15 at one of the ‘spoke’ sites, a 92.5% decline.

It is possible to successfully treat patients with acute ischemic stroke at remote sites through videoconferencing or telephone consultation. Telestroke can also lead to a significant reduction in the number of patients requiring transfer to a tertiary care centre.

Canadian provinces boast one of the most sophisticated telemedicine infrastructures in the world. Feasibility of epilepsy care through telemedicine is established, but its use by practicing neurologists is unknown. The Canadian League against Epilepsy's telemedicine task force conducted this study to understand the perceptions, barriers and usage of telemedicine in epilepsy care.

Using a 14 item questionnaire we prospectively surveyed all the epileptologists across Canada with regards to current use, perceived benefits and barriers to the use of telemedicine. The survey was mailed out to 76 neurologists who had a primary interest in epilepsy.

We received 39 responses (54.1%) spanning seven provinces. Majority of the responders were 50 years and over (56.4%). Although 61.5% of the physicians acknowledged a need for tele-epilepsy services, the majority (64.1%) had not used telemedicine. The most common forms of technology were videoconferencing and telephone but some physicians had also used email. Telemedicine was mainly used for clinical and educational purposes. 79.5% of physicians had access to videoconferencing equipment and 61.5% assessed that there was a need/use for clinical telehealth. The main perceived obstacles in the use of telemedicine were: lack of infrastructure support and remuneration problems followed by limitations in clinical examination.

Although widely available, telemedicine is under-utilized in epilepsy care. Most of the obstacles can be easily fixed and overcome through education and simple interventions. Partnering of epilepsy centers across Canada in the development of a comprehensive national telemedicine network would create an excellent opportunity to expand epilepsy care.

To ensure the overall quality of our electroencephalogram (EEG) laboratory, we decided to perform an audit of EEGs interpreted at our institution, focusing initially on EEGs reporting temporal abnormalities.

Reports of all EEGs performed between January 1st and June 30th, 2006 were reviewed in order to identify tracings mentioning abnormalities in the temporal regions. These records were then independently reviewed by two epileptologists on two distinct occasions, separated by an interval of at least six months. If the recording was considered normal after this process, the cause for misinterpretation was identified and the patient's chart was reviewed to determine if he was epileptic or not based on available evidence until June 2009.

In the first half of 2006,143 out of 773 EEGs mentioned temporal abnormalities (18.5%). In general, intra- and interrater agreement ratios between our two epileptologists were moderate to substantial for normality, presence of epileptic activity and presence of slowing. Forty-five recordings (31.5%) were reported as normal independently by them on two distinct sittings six months apart. The most common causes for misinterpretation were the presence of benign epileptiform variants, normal sharply contoured patterns of somnolence or hyperventilation. Chart review confirmed that most were non-epileptic patients (60% non-epileptic, 27% epileptic, 13% unknown).

Moderate to substantial intra- and interrater agreement as well as frequent misinterpretation of physiological variants indicate that some corrective measures need to be implemented to improve the consistency of EEG interpretation amongst our group of electroencephalographers.