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Background: Mobile stroke units ( MSU s), equipped with an integrated computed tomography scanner, can shorten time to thrombolytic treatment and may improve outcome in patients with acute ischemic stroke. Original (German) MSU s are staffed by neurologists trained as emergency physicians, but patient assessment and treatment decisions by a remote neurologist may offer an alternative to neurologists aboard MSU. Methods and Results: Remote neurologists examined and assessed emergency patients treated aboard the MSU in Berlin, Germany. Audiovisual quality was rated by the remote neurologist from 1 (excellent) to 6 (insufficient), and duration of video examinations was assessed. We analyzed interrater reliability of diagnoses, scores on the National Institutes of Health Stroke Scale and treatment decisions (intravenous thrombolysis) between the MSU neurologist and the remote neurologist. We included 90 of 103 emergency assessments (13 patients were excluded because of either failed connection, technical problems, clinical worsening during teleconsultation, or missing data in documentation) in this study. The remote neurologist rated audiovisual quality with a median grade for audio quality of 3 (satisfactory) and for video quality of 2 (good). Mean time for completion of teleconsultations was about 19��5 minutes. The interrater reliabilities between the onboard and remote neurologist were high for diagnoses (Cohen's ��=0.86), National Institutes of Health Stroke Scale sum scores (intraclass correlation coefficient, 0.87) and treatment decisions (16 treatment decisions agreed versus 2 disagreed; Cohen's ��=0.93). Conclusions: Remote assessment and treatment decisions of emergency patients are technically feasible with satisfactory audiovisual quality. Agreement on diagnoses, neurological examinations, and treatment decisions between onboard and remote neurologists was high.

In dieser Studie wurden Patienten mit kongenitaler Prosopagnosie im Vergleich zu einer Gruppe von Kontrollprobanden mittels umfangreicher neuropsychologischer, elektrophysiologischer und bildmorphologischer Methoden charakterisiert. Im Rahmen der neuropsychologischen Testung konnte nachgewiesen werden, dass sich die beiden Untersuchungsgruppen einzig hinsichtlich der Gesichtererkennung signifikant voneinander unterschieden, während sie in den Bereichen der allgemeinen kognitiven Leistungsfähigkeit, der basalen visuellen Fähigkeiten sowie der Objekterkennung und -verarbeitung gleichermaßen normale bis überdurchschnittliche Ergebnisse aufwiesen. Aus den simultan durchgeführten elektro- und magnetoenzephalographischen Messungen konnte herausgearbeitet werden, dass sich die frühen neuronalen Korrelate gesichterselektiver Aktivität bei den Patienten signifikant von denen der Kontrollgruppe unterschieden. Diese Unterschiede zeigten sich einerseits in Form einer Amplitudenreduktion der gesichterspezifischen M170 bei den Patienten, andererseits war die Latenz der M170 um 15 ms verzögert. Elektroenzephalographisch ergab sich zwar eine Tendenz hin zu einer Latenzverzögerung der N170; diese wurde jedoch in keiner Messung signifikant. Im Bereich der Objektverarbeitung ließen sich hingegen keine elektrophysiologischen Differenzen nachweisen. Darüber hinausgehend konnten korrelative Zusammenhänge zwischen der Amplitude der durch Gesichter ausgelösten M170 und der Leistungsfähigkeit der Gesichtererkennung bei Kontrollprobanden, nicht jedoch bei der Patientengruppe nachgewiesen werden. Zusammenfassend lässt sich aus den neuropsychologischen und elektrophysiologischen Analysen folgern, dass die Gesichterverarbeitung bei Patienten mit kongenitaler Prosopagnosie sowohl im Bereich der strukturellen Enkodierung als auch auf der Ebene der Bildung und Aktivierung stabiler Repräsentationen in Form der face recognition units gestört ist. Aus den Daten lässt sich mit hoher Wahrscheinlichkeit schließen, dass der kongenitalen Prosopagnosie ein isoliertes dysfunktionales Modul der Gesichtererkennung zugrunde liegt. Die Ergebnisse dieser Studie erhöhen die Evidenz für eine hochspezialisierte modulare Verarbeitung von Gesichtern. Zusätzlich lassen sich aus den hier dargestellten Ergebnissen Hinweise ableiten, dass die verschiedenen für die Gesichterverarbeitung zuständigen Regionen bei Patienten mit Prosopagnosie anders als bei Kontrollprobanden aktiviert werden. Eine sichere Zuordnung neuronaler Quellen war jedoch im Rahmen der explorativen Analyse dieser Arbeit nicht möglich. Hier sind im weiteren Verlauf der Forschung zusätzliche Messungen erforderlich, um zu klären, welche neuronalen Ensembles bei den Patienten mit kongenitaler Prosopagnosie dysfunktional sind., In this study patients with congenital prosopagnosia were compared to a group of matched controls by means of extensive neuropsychological, electrophysiological and brain imaging methods. To confirm the diagnosis both the target and control group underwent thorough neuropsychological testing. In a large variety of tests assessing functions other than face processing (general cognitive performance, basic visual abilities, object recognition and object processing) subjects with congenital prosopagnosia scored in the normal range or above average. Only in the tests of face processing did subjects with congenital prosopagnosia score significantly lower than normal controls. The analysis of the simultaneously recorded electro- and magnetoencephalographic measurements substantiated the assumption that the early neuronal correlates of face selective activity distinguish the group of patients from unimpaired subjects: in the group of subjects with congenital prosopagnosia the M170 amplitude for faces was significantly lower and the M170 peak for faces was significantly delayed (15 ms). Encephalography did not reveal a significant reduction or delay of the N170; only a tendency to a delay of the N170 was detected. Moreover, it was possible to ascertain correlations between the amplitude of the M170 evoked by faces and the efficiency of face recognition in control subjects, but not in the group of patients. From all these neuropsychological and electrophysiological analyses it follows that face processing in patients with congenital prosopagnosia is disturbed both in the area of structural encoding and at the level of the formation and activation of stable representations in the form of face recognition units. From the data it can be concluded that in all probability an isolated dysfuncional module forms the basis of congenital prosopagnosia. The results of this study increase the evidence that face recognition rests on highly specialized modular face processing. In addition, the results presented here indicate that the regions responsible for face processing are activated in different ways in patients with prosopagnosia, on the one hand, and in control subjects, on the other. Owing to the explorative character of this study the neuronal sources of prosopagnosia could not be reliably mapped. In the course of further research additional measurements will be necessary to determine which neuronal ensembles are dysfunctional in patients with congenital prosopagnosia.

Time to thrombolysis is crucial for outcome in acute ischemic stroke.To determine if starting thrombolysis in a specialized ambulance reduces delays.In the Prehospital Acute Neurological Treatment and Optimization of Medical care in Stroke Study (PHANTOM-S), conducted in Berlin, Germany, we randomly assigned weeks with and without availability of the Stroke Emergency Mobile (STEMO) from May 1, 2011, to January 31, 2013. Berlin has an established stroke care infrastructure with 14 stroke units. We included 6182 adult patients (STEMO weeks: 44.3% male, mean [SD] age, 73.9 [15.0] y; control weeks: 45.2% male, mean [SD] age, 74.3 [14.9] y) for whom a stroke dispatch was activated.The intervention comprised an ambulance (STEMO) equipped with a CT scanner, point-of-care laboratory, and telemedicine connection; a stroke identification algorithm at dispatcher level; and a prehospital stroke team. Thrombolysis was started before transport to hospital if ischemic stroke was confirmed and contraindications excluded.Primary outcome was alarm-to-thrombolysis time. Secondary outcomes included thrombolysis rate, secondary intracerebral hemorrhage after thrombolysis, and 7-day mortality.Time reduction was assessed in all patients with a stroke dispatch from the entire catchment area in STEMO weeks (3213 patients) vs control weeks (2969 patients) and in patients in whom STEMO was available and deployed (1804 patients) vs control weeks (2969 patients). Compared with thrombolysis during control weeks, there was a reduction of 15 minutes (95% CI, 11-19) in alarm-to-treatment times in the catchment area during STEMO weeks (76.3 min; 95% CI, 73.2-79.3 vs 61.4 min; 95% CI, 58.7-64.0; P .001). Among patients for whom STEMO was deployed, mean alarm-to-treatment time (51.8 min; 95% CI, 49.0-54.6) was shorter by 25 minutes (95% CI, 20-29; P .001) than during control weeks. Thrombolysis rates in ischemic stroke were 29% (310/1070) during STEMO weeks and 33% (200/614) after STEMO deployment vs 21% (220/1041) during control weeks (differences, 8%; 95% CI, 4%-12%; P .001, and 12%, 95% CI, 7%-16%; P .001, respectively). STEMO deployment incurred no increased risk for intracerebral hemorrhage (STEMO deployment: 7/200; conventional care: 22/323; adjusted odds ratio [OR], 0.42, 95% CI, 0.18-1.03; P = .06) or 7-day mortality (9/199 vs 15/323; adjusted OR, 0.76; 95% CI, 0.31-1.82; P = .53).Compared with usual care, the use of ambulance-based thrombolysis resulted in decreased time to treatment without an increase in adverse events. Further studies are needed to assess the effects on clinical outcomes.clinicaltrials.gov Identifier: NCT01382862.