Positive Family History Of Stroke Research Articles

Frequency of risk factors for stroke in young Pakistani population

Background and Objective:
 There is paucity of data regarding risk factors of stroke in young Pakistanis. The objective of this study was to identify the frequency of risk factors for ischemic stroke in the young Pakistani population
 Methods:
 This was a retrospective Cross sectional study conducted at Aziz Fatima Hospital Neurology outpatient’s department between January 2022 to April 2022.bAll patients presenting with an ischemic stroke within the past month and age between 20 and 49 years were included. Data was collected from patient notes using a table which listed the patient’s demographic information and risk factors. All the patients had appropriate investigations on site to look for cardiac and vessel abnormalities along with relevant blood tests. The results were then assessed using univariate analysis to divide patients according to age, gender and prevalence of risk factors.
 Results:
 A total of 53 patient’s data was collected. The mean age was 39 years. The commonest risk factor was hypertension (58%). The other risk factors were ischemic heart disease (36%), diabetes mellitus (34%), dyslipidemia (26%), smoking (21%), obesity (19%), atrial fibrillation (2%) and vasculitis (2%). Positive family history of stroke was found in 26%.
 Conclusion:
 Hypertension was the commonest risk factor for young age group under 50 years, followed by ischemic heart disease. Our younger population also had a higher frequency of causes like diabetes mellitus, dyslipidemia and smoking.

Incidence and Predictors of Acute Symptomatic Seizures After Stroke at A Tertiary Care Hospital

Neurological deterioration can occur in approximately 15% of patients with acute stroke. Several mechanisms can lead to ischemic lesion extension and subsequent neurological worsening, including re-occlusion, edema progression, and cardiovascular instability. Stroke is one of the main causes of morbidity and mortality worldwide. Objective: To determine the Incidence and predictors of acute symptomatic seizures after stroke at a tertiary care hospital. Methods: This Descriptive Cross-Sectional Study was conducted at Department of Neurology, Civil Hospital, Karachi, Pakistan, from April 19, 2019 to October 18, 2019. Informed consent from all the patients who fulfilled the inclusion criteria was taken after explaining the procedure, risks and benefits of the study. CT scan & continuous twelve-lead ECG were performed. Assessment for associated factors of ischemic stroke i.e., seizure, atrial fibrillation and family history of stroke were noted. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: Mean ± SD of age was found to be 63.14±16.7 years. Out of 251 patients, 137 (54.6%) patients were male and 114 (45.4%) were female. Diabetes Mellitus was noted in 97 (38.6%) patients. Factors associated with acute ischemic stroke i.e., seizure was noted in 31 (12.1%) while atrial fibrillation was noted in 68 (27.1%) patients and positive family history of stroke was documented in 46 (18.3%). Conclusions: It is to be concluded that atrial fibrillation was found to be the major modifiable associated factors in the development of stroke. Controlling of these risk factors might reduce the risk of stroke.

Association between PAI-1 Polymorphisms and Ischemic Stroke in a South Korean Case-Control Cohort.

Stroke is the second leading cause of death in the world. Approximately 80% of strokes are ischemic in origin. Many risk factors have been linked to stroke, including an increased level of plasminogen activator inhibitor-1 (PAI-1). PAI-1 levels increase and remain elevated in blood during the acute phase of ischemic stroke, which can impair fibrinolytic activity, leading to coronary artery disease and arterial thrombotic disorders. Here, we present a case-control study of 574 stroke patients and 425 controls seen for routine health examination or treatment for nonspecific dizziness, nonorganic headache, or anxiety for positive family history of stroke at the Bundang Medical Center in South Korea. Polymorphisms in PAI-1 were identified by polymerase chain reaction/restriction fragment length polymorphism analysis using genomic DNA. Specifically, three variations (-675 4G>5G, 10692T>C, and 12068G>A) were linked to a higher overall prevalence of stroke as well as a higher prevalence of certain stroke subtypes. Haplotype analyses also revealed combinations of these variations (-844G>A, -675 4G>5G, 43G>A, 9785A>G, 10692T>C, 11053T>G, and 12068G>A) that were significantly associated with a higher prevalence of ischemic stroke. To the best of our knowledge, this is the first strong evidence that polymorphic sites in PAI-1 promoter and 3'-UTR regions are associated with higher ischemic stroke risk. Furthermore, the PAI-1 genotypes and haplotypes identified here have potential as clinical biomarkers of ischemic stroke and could improve the prognosis and future management of stroke patients.

Partial loss of function of colony-stimulating factor 1 receptor in a patient with white matter abnormalities.

Mutations in colony-stimulating factor 1 receptor (CSF1R) cause adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP). Patients with ALSP can be misdiagnosed as having acute ischemic stroke due to hyperintensity lesions on diffusion-weighted magnetic resonance imaging. Mutant CSF1R proteins identified in ALSP show a complete loss of autophosphorylation of CSF1R. We conducted mutation screening of CSF1R in 123 patients with definite acute ischemic cerebrovascular syndrome and positive family history of stroke. The pathogenicity of identified variants was evaluated using functional analyses. The levels of autophosphorylation of CSF1R in response to treatment with ligands of CSF1R were examined in cells transfected with wild-type and mutant CSF1R. We identified eight CSF1R variants, six were known non-pathogenic polymorphisms, whereas the other two were missense variants inducing substitution of amino acid residues (p.Glu573Lys and p.Gly747Arg). Functional assay showed that the levels of autophosphorylation of p.Gly747Arg were similar to those of wild-type when treated with ligands. The autophosphorylation of p.Glu573Lys was detectable, but significantly decreased compared with those of wild-type CSF1R (P < 0.001, two-way anova with Bonferroni). The clinical presentation of the patient with p.Glu573Lys was consistent with cerebral embolism. The patient did not have typical clinical findings of ALSP. However, periventricular white matter abnormalities, unrelated to the recent infarct, were evident on brain magnetic resonance imaging. In contrast to ALSP-associated missense mutations, CSF1R p.Glu573Lys variant in a patient with acute ischemic cerebrovascular syndrome showed a partial loss of autophosphorylation of CSF1R; its clinical significance warrants further investigation.

SENSITIVITY OF TRANSCRANIAL DOPPLER AND TRANSOESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF PATENT FORAMEN OVALE IN CRYPTOGENIC STROKE

BackgroundPatent foramen ovale (PFO) has been associated with otherwise cryptogenic stroke. The pathway of investigation of PFO varies among centres. We compared the sensitivity and specificity of transoesophageal echocardiography (TOE)...

Estimating the Magnitude of Genetic Factors by Calculating the Genetic Relative Risk of Stroke in First-Ever Lacunar Stroke Patients

BackgroundPositive family history of stroke is an independent risk factor for lacunar stroke. However, the magnitude of familial aggregation of a certain disease is better evaluated by the genetic relative risk. This is calculated by dividing the prevalence of specific disease in family members of patients by the prevalence of this disease in the general population. In a cohort of lacunar stroke patients, who were subtyped clinically and radiologically, we determined the genetic relative risk of stroke.MethodsBy questionnaire and additional interview, we obtained a complete first-degree family history of stroke. The prevalence of stroke in first-degree relatives of these lacunar stroke patients was compared to the self-reported prevalence of stroke in a Dutch community based cohort of elderly volunteers. Secondly, the influence of proband characteristics and family composition on parental and sibling history of stroke were evaluated.Principal FindingsWe collected data of 1066 first-degree relatives of 195 lacunar stroke patients. Strokes occurred in 13.5% of first-degree relatives. The genetic relative risk was 2.94 (95%CI 2.45–3.53) for overall first-degree relatives, 4.52 (95%CI 3.61–5.65) for patients' parents and 2.10 (95%CI 1.63–2.69) for patients' siblings. Age of proband and proband status for hypertension influenced the chance of having a parent with a history of stroke whereas the likelihood of having a concordant sibling increased with sibship size.ConclusionsWe found an increased genetic relative risk of stroke in first-degree relatives of patients with lacunar stroke. Our data warrant further genomic research in this well-defined high risk population for stroke.

Family History of Stroke Is an Independent Risk Factor for Lacunar Stroke Subtype With Asymptomatic Lacunar Infarcts at Younger Ages

Results from case-control and case-case studies indicate that a positive family history of stroke (FHstroke) is an independent risk factor for lacunar stroke. Different lacunar stroke phenotypes can be distinguished on the basis of the presence of asymptomatic lacunar infarcts (aLACs), ischemic white-matter lesions, or brain microbleeds. The aim of the present study was to determine whether familial aggregation of stroke was different for lacunar stroke phenotypes. In 157 patients with a first-ever lacunar stroke, a complete first-degree FHstroke was obtained by a standardized questionnaire and additional interview. Lacunar stroke patients were categorized successively into groups, depending on the presence of aLACs, ischemic white-matter lesions, and brain microbleeds on magnetic resonance imaging. Fifty-two percent of patients reported a positive FHstroke in at least one of their first-degree relatives. In younger (<65 years) probands, a high frequency of parental FHstroke (59% versus 20%, P<0.01) in those with aLACs compared with probands without aLACs was found. In multivariate analysis, the strongest associations were found for parental FHstroke (odds ratio=6.46; 95% CI=1.96 to 21.33), maternal FHstroke (odds ratio=4.00; 95% CI=1.18 to 13.56), and paternal FHstroke (odds ratio=5.40; 95% CI=1.14 to 25.61). A family history of stroke might be an independent risk factor for the lacunar stroke phenotype with aLACs at younger ages, suggesting a role for genetic factors in this phenotype caused by diffuse vasculopathy.

Risk factors for stroke

Stroke is the third cause of mortality both in men and in women throughout the world. In Serbia, stroke is the first cause of mortality in women older than 55 years of age and the second cause of death in men of the same age. Both ischemic heart diseases and ischemic stroke correlate with the same predisposing, potentially modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity, diabetes mellitus). Stroke does not usually occur on its own. Patients with stroke have a high prevalence of associated medical problems. These conditions may predict the stroke ("preexisting conditions"), occur for the first time after stroke ("post-stroke complications"), or present as manifestations of preexisting medical conditions after stroke. Risk factors for stroke are divided into the three groups: risk factors which cannot be influenced on such as: age, gender, positive family history of stroke, race: those which are modifiable such as: hypertension, diabetes mellitus, smoking cigarettes, obesity, physical inactivity and the third group consists of potential risk factors for stroke (consumption of alcohol, hormones, changes in fibrinolysis, changes in blood. Stroke remains a leading cause of long-term disability and premature death of both men and women. Consequently, stroke survivors are often handicapped and doomed to sedentary lifestyle which restrains performance of activities of daily living, increases the risk for falls, and may contribute to a higher risk for recurrent stroke and cardiovascular disease. Prevention of stroke is still a great medical and social problem. Further studies are required to investigate potential risk factors for the occurrence of stroke as well as the measures of primary and secondary prevention.

Sudden hearing loss due to fibromuscular dysplasia

This case is reported in order to demonstrate the importance of detailed clinical analysis, including evaluation of personal and family history, in the differential diagnosis of sudden sensorineural hearing loss. A 50-year-old woman presented with a sudden onset of sensorineural hearing loss in her right ear. She had experienced three previous episodes of sudden sensorineural hearing loss in her left ear, at the ages of 35, 48 and 50 years. She also reported suffering two strokes with left hemiparesis due to fibromuscular dysplasia of her right internal carotid artery. A positive family history of stroke among maternal relatives suggested autosomal dominant inheritance. The patient's personal and family history suggested a rare cause of sudden sensorineural hearing loss, for which alternative therapeutic modalities may be applicable in selected cases. Careful follow up of any patient with sudden sensorineural hearing loss and evaluation of their personal and family history is essential, in order to uncover evidence of rare underlying causes of sudden sensorineural hearing loss. For patients with such rare diagnoses, alternative therapy and surveillance modalities may be useful in disease management, depending on pre-existing pathology. Those patients should be managed via a multidisciplinary approach, including genetic counselling, in order to achieve the best possible outcome.

Prevalence of Stroke and Stroke Symptoms: A Population-Based Survey of 28,090 Participants

Background: Stroke is associated with a considerable burden of disease worldwide. Data about prevalence needs regular updating to facilitate health care planning and resource allocation. The purpose of the present study was to determine stroke prevalence in a large urban population in an easy and reliable way. Methods:In a population survey a total of 75,720 households with at least 1 person ≧50 years received information about stroke symptoms by mail. In addition, the Stroke Symptom Questionnaire assessing the prevalence of stroke and of stroke symptoms was sent. Stroke prevalence was determined by a single physician-diagnosed stroke-screening question or by the combination of the latter with reported visual impairment and/or articulation problems in the past. Results: A total of 28,090 persons responded (37.5%). Mean (±SD) age was 64.4 ± 9.7 years, 62.9 ± 8.9 for men (43.3%), and 65.5 ± 10.2 for women. Of all participants 2.7% reported impaired vision, 2.8% facial weakness, 2.8% articulation problems, 3.9% limb weakness, and 5% sensory disturbances. A total of 4.5% reported a physician-diagnosed stroke (women 4.3%; men 4.9%). Combining reported stroke history with reported impaired vision and/or articulation problems, the prevalence of stroke increased to 7.6% (men 8.4%; women 7.2%). Factors associated with higher prevalence were higher age, male gender, non-German nationality, lower education, positive family history of stroke, and living alone. Conclusions: The combination of questions concerning a prior stroke and stroke symptoms is a useful and easy approach to assess prevalence. It results in prevalence numbers which might compensate for an underestimation of stroke numbers.

Do Women Have Worse Outcome After Stroke Caused by Intracranial Arterial Stenosis?

See related article, pages 2055–2062. Stroke affects both women and men, but it is the leading cause of mortality in women.1 Although many aspects of the disease are similar in women and men, there is a growing body of evidence to support sex (a biologic status determined by sex chromosomes and sex hormones) and gender (sex determined by social, cultural, and educational context) differences in the epidemiology of stroke. Numerous reports have demonstrated sex-specific differences in the prevalence, clinical presentation, management, recanalization rate of intracranial artery stenosis after intravenous or intra-arterial thrombolysis in acute ischemic stroke, and clinical outcomes of stroke of all subtypes.2–6 The results are, however, often conflicting and there is a paucity of randomized controlled trial support regarding sex-related stroke care delivery. The recent gender-specific analysis from the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study7 provided very important evidence that women with symptomatic intracranial arterial stenosis have considerable increased risk for stroke and vascular death than men. These data contrast a common perception that men have greater risk of recurrent stroke then women. The WASID study had a good representation of women (38%), similar to the NINDS Stroke TPA study (42%),8 and the recent SPARCL study (40%),9 but in comparison to these studies showed a considerate gender-specific difference in stroke outcome. Women in the WASID study had more comorbidities (except coronary artery disease), higher body mass index and total cholesterol, were more sedentary but consumed less alcohol and cigarettes, had positive family history of stroke, and had different sociodemographic characteristics. In addition, women were more likely to have intracranial stenosis of the middle cerebral artery, but the proportion of severe intracranial artery stenosis was not different in men. Women had a considerable greater risk of …

Family History Associated with Improved Functional Outcome following Ischemic Stroke

Background: Few studies to date have documented genetic influences on outcomes of hospitalization among patients with acute ischemic stroke. Objective: To assess the influence of the family history of stroke on in-hospital mortality and hospitalization outcome among patients having acute ischemic stroke. Methods: The medical records for 916 consecutive adult patients admitted for acute ischemic stroke during 12/1/2001–2/28/2002 at 34 randomly selected Georgia hospitals were centrally abstracted. The patients were classified as having a positive family history of stroke or not. The two groups were compared on risk factors, comorbidities, admission characteristics, hospital disposition status, and outcome measures. Multivariate logistic regression was used to assess the independent contributions of important variables identified by univariate screening. Results: A positive family history of stroke was significantly associated with a decreased frequency of medical history of coronary artery disease, a decreased frequency of medical history of congestive heart failure, an increased frequency of medical history of hypertension, and younger age among patients with acute ischemic stroke who were 18 years or older. The family history was not associated with in-hospital mortality (odds ratio 1.49, 95% confidence interval 0.79–2.80 for incident cases). The interaction of family history and age was significantly associated with discharge destination and discharge functional status. Conclusions: Preliminary analyses found associations between family history and stroke outcome. The role of a family history of stroke in stroke outcome merits further study.

1161 Southern Egypt stroke study

Background: Stroke now ranks as the second cause of death and the most common life threatening neurological disease. The best approach to reducing the burden of stroke remains prevention. Objectives: to determine the distribution of stroke in Upper Egypt by type, stroke risk factors , and to compare the results of the study with other national & international studies. Methods: prospective hospital-based study carried out in Neurology department of Sohag University hospital, involved 467 stroke patients. patients were subjected to history taking, examination and investigation. Demographic data, stroke-subtypes, stroke-prone individual, risk factors, and stroke outcome, were analyzed and compared with other multi-center, national and international studies. Results: hemorrhagic strokes reported in37.5%. 56.3% were above 60 years and 8.6% were below 40 years. 62% of stroke occurred in autumn-winter. Hemorrhagic stroke was higher in spring-summer. (53%). Stroke reported more in rural areas 57% .Non educated stroke patients were the commonest 67.5%, hypertension reported in 42% of patients, more in males 59%, especially in those>40years(97.4%), smoking in 37.7%, ischemic heart diseases in 32.8%, dyslipidaemia in 29.5%, history of TIA in 23.1% of, Diabetes in 21.6% of, Past history of similar stroke in 10.5%, obesity in 10.1%, Positive family history of stroke in 9.6%, atrial fibrillation in 6%, 60%. Rheumatic heart diseases reported in 5.6% of patients. Alcohol abuse reported in only 1.3% 66%. Conclusion: In Upper Egypt, we reported a higher incidence of Hemorrhagic stroke .Lower incidences of, hypertension, D.M., hyperlipidemia, previous attacks and alcohol consumption compared with other studies, higher rates of Rh.H.D. were reported compared with other international studies. (Egypt J. Neurol. Psychiat.

Clinically translated ischemic stroke genomics.

Cohort studies show that having a positive family history of stroke increases the odds of having a stroke by approximately 30%. The heritability of stroke appears to be heterogeneous across ischemic stroke subtypes, with cardioembolic stroke being least heritable. The relative influence of stroke risk attenuates with age, but genetics does not cease to be relevant in later adulthood. Recent family history and twin studies suggest that genetic factors remain relevant even beyond the seventh decade of life. One of the challenges of gene discovery in stroke relates to the complexities of phenotype. The complexities of phenotype can be addressed by focusing on individual ischemic stroke subtypes or by studying intermediate phenotypes like leukaraiosis, which has a heritability of approximately 70%. Although most stroke genetics research has focused on the identification of risk factor genes, an independent set of genes likely influences poststroke outcomes (for example, apolipoprotein E) and response to drug therapies (example, alpha-adducin and diuretic therapy).

Familial clustering of stroke according to proband age at onset of presenting ischemic stroke.

The magnitude of inherited risk of stroke may lessen with age, and this would have implications for optimizing genomic approaches to identifying genetic risk factors for stroke. We investigated the relationship between age and inherited risk of stroke. Family histories of stroke were obtained in systematic interviews with 310 adult men and women with recent CT- or MR-confirmed ischemic stroke. Probability of stroke in first-degree relatives was analyzed by logistic regression, adjusting for sibship size. The probability of having a sibling with stroke increased as proband age at stroke presentation increased. Per decade increase in proband age, the odds ratio was 1.65 (95% confidence interval [CI], 1.20 to 2.28; P=0.002) for a concordant sibling and 1.69 (95% CI, 1.15 to 2.49; P=0.008) for >or=2 first-degree relatives with a history of stroke. Clustering of stroke was not greater in families with probands manifesting symptoms of stroke in earlier than later adulthood. The relationship between proband age and positive family history of stroke does not suggest an upper age-limit cutoff for genomewide linkage studies.

Feasibility of an affected sibling pair study in ischemic stroke: results of a 2-center family history registry.

We sought to determine pedigree availability for a concordant sibling pair study of genetic risk factors in ischemic stroke. Probands with confirmed ischemic stroke were prospectively enrolled. Family histories were obtained by systematic interview. A study neurologist prospectively assigned stroke subtype. Of 310 probands (median age, 75 years; range, 26 to 97 years; 48% women), 75% had at least 1 living sibling; 10%, at least 1 concordant living sibling; 2%, at least 1 concordant sibling living in the same city; and 7%, at least 1 concordant living and 1 discordant living sibling. Likelihood of having a concordant sibling increased significantly with proband age, even after adjustment for sibship size (P=0.002). Positive family history of stroke was not related to either proband stroke subtype or risk factor profile. Approximately 10 probands were screened to find 1 potentially concordant living sibling. A concordant sibling pair study should be multicentered and enable enrollment of siblings from diverse geographic areas.

Ischemic Stroke Mechanism and Likelihood of Having a Positive Family History of Stroke

P122 Introduction: It is not known whether the magnitude of the inherited component to ischemic stroke risk varies according to presumed mechanism. Differences in familial aggregation of stroke might imply differences in the magnitude of inherited stroke risk. Methods: Probands were eligible for entry into a two-center prospective consecutive patient registry if they presented with an ischemic stroke within 180 days of onset of symptoms. Stroke was defined using WHO criteria. A stroke was considered ischemic if CT or MR imaging done within 7 days of onset of symptoms failed to reveal an alternative diagnosis. Probands were excluded if they had onset of symptoms within 48 hours of a cerebrovascular or cardiovascular proceedure or within 60 days of a nontraumatic subarachnoid hemorhage. Probands were also excluded if they were known to have: CADASIL, Fabry’s disease, homocysteinuria, MELAS, sickle cell disease, mechanical aortic or mitral valve, or biopsy-proven CNS vasculitis. Proband family history was obtained by systematic interview of the proband or next-of-kin. Proband past medical history was obtained by proband interview, record review, or both. A neurologist confirmed the diagnosis of and assigned a TOAST subtype to all index ischemic strokes. A positive family history was defined as a history of stroke in at least one parent or full sibling. Results: We enrolled 283 probands (median age, 75 yrs; male, 52%). Frequencies of TOAST subtypes were: cardioembolic, 17.0% (n=48); large-vessel, 24.7% (n=70); small-vessel, 23.0% (n=65); other, 2.5% (n=7); and unknown, 32.9% (n=93). Frequencies of positive family history by proband ischemic stroke subtype were: cardioembolic, 43.8% (95%CI, 29.5–58.8); large-vessel, 40.0% (95%CI, 28.5–52.4); small-vessel, 47.7% (95%CI, 35.1–60.5); other, 42.9% (95%CI, 9.9–81.6%); and unknown 48.8% (95%CI, 37.9–59.0). Frequencies were not significantly different among subtypes (P=0.718, chi square). Conclusions: The magnitude of inherited risk may not differ dramatically for various clinical subtypes of ischemic stroke. Qualitative differences in inherited stroke risk may exist at the molecular level.

Ischemic Stroke Mechanism and Likelihood of Having a Positive Family History of Stroke

P122 Introduction: It is not known whether the magnitude of the inherited component to ischemic stroke risk varies according to presumed mechanism. Differences in familial aggregation of stroke might imply differences in the magnitude of inherited stroke risk. Methods: Probands were eligible for entry into a two-center prospective consecutive patient registry if they presented with an ischemic stroke within 180 days of onset of symptoms. Stroke was defined using WHO criteria. A stroke was considered ischemic if CT or MR imaging done within 7 days of onset of symptoms failed to reveal an alternative diagnosis. Probands were excluded if they had onset of symptoms within 48 hours of a cerebrovascular or cardiovascular proceedure or within 60 days of a nontraumatic subarachnoid hemorhage. Probands were also excluded if they were known to have: CADASIL, Fabry’s disease, homocysteinuria, MELAS, sickle cell disease, mechanical aortic or mitral valve, or biopsy-proven CNS vasculitis. Proband family history was obtained by systematic interview of the proband or next-of-kin. Proband past medical history was obtained by proband interview, record review, or both. A neurologist confirmed the diagnosis of and assigned a TOAST subtype to all index ischemic strokes. A positive family history was defined as a history of stroke in at least one parent or full sibling. Results: We enrolled 283 probands (median age, 75 yrs; male, 52%). Frequencies of TOAST subtypes were: cardioembolic, 17.0% (n=48); large-vessel, 24.7% (n=70); small-vessel, 23.0% (n=65); other, 2.5% (n=7); and unknown, 32.9% (n=93). Frequencies of positive family history by proband ischemic stroke subtype were: cardioembolic, 43.8% (95%CI, 29.5–58.8); large-vessel, 40.0% (95%CI, 28.5–52.4); small-vessel, 47.7% (95%CI, 35.1–60.5); other, 42.9% (95%CI, 9.9–81.6%); and unknown 48.8% (95%CI, 37.9–59.0). Frequencies were not significantly different among subtypes (P=0.718, chi square). Conclusions: The magnitude of inherited risk may not differ dramatically for various clinical subtypes of ischemic stroke. Qualitative differences in inherited stroke risk may exist at the molecular level.

Tortuosity of carotid and vertebral arteries: a magnetic resonance angiographic study.

Nine patients (group A) were found on magnetic resonance angiography (MRA) to have excessive carotid artery, vertebral artery, and vertebrobasilar junction tortuosity. A control group (group B) were age- and sex-matched to group A patients, were selected randomly from our MRA or stroke data banks, and had not undergone MRA for evaluation of migraine, "carotidynia," or pulsatile tinnitus. Factors more prevalent in group A patients included migraine, chronic daily headache, carotidynia, pulsatile tinnitus, and a positive family history of headache. Factors more prevalent in group B patients included a positive family history of stroke, large-vessel atherosclerosis, and scan evidence of ischemic infarctions; many group B patients had undergone MRA for stroke or transient ischemic attack evaluation. Men were slightly underrepresented at 44%, and were younger than women (34 +/- 6 years vs. 43 +/- 3 years; p = 0.01). Relationships in this preliminary study between arterial tortuosity and migraine seem evident.

Cerebrovascular Disease: Precursors and Prevention.

Allthough progress is being made in treatment of acute ischemic stroke to reduce the size of the cerebral infarct and thereby lessen the severity of the neurologic deficit, it seems likely that prevention holds the key to reducing death and disability from stroke. Prevention requires the major stroke precursors to be identified, these include risk factors; increasing blood pressure level, diabetes, cigarette smoking, low levels of physical activity, increased fibrinogen level; positive family history of stroke, extremes of alcohol consumption; left ventricular enlargement either left ventricular hypertrophy by ECG (or preferably left ventricular mass by echocardiography), as well as predisposing diseases; coronary heart disease, cardiac failure, and atrial fibrillation. Other cardiac abnormalities, increased left atrial size and mitral annular calcification have also been implicated. High total cholesterol or low HDL-cholesterol has not been consistently related to ischemic stroke, while low levels of total cholesterol have been related to intracerebral hemorrhage.Clinical trials have provided evidence that reducing blood pressure, systolic as well as diastolic, reduces stroke incidence and that warfarin anti-coagulation prevents stroke in atrial fibrillation. Recent trials of rigid control of blood sugar in insulin dependent diabetics suggest that vascular complications may also be prevented by improved management. Observational data strongly support cessation of cigarette smoking and promotion of moderate physical activity as a means of significant stroke reduction. Recent trials of HMG CoA reductase inhibitors for cholesterol reduction have disclosed a striking reduction in cardiovascular events including stroke perhaps via an effect of these drugs on plaque rupture, lesion activation and endothelial dysfunction. Elevated plasma homocysteine levels, amenable to reduction with vitamins particularly folic acid, have also recently been implicated.Identification of persons at increased risk, accounting for the cumulative effect of multiple risk factor abnormalities, is key to stroke prevention. A Framingham stroke risk profile identifies those at high risk and provides each individual's conditional probability of stroke. These high risk individuals can thus be alerted so effective preventive measures may be instituted.