High prevalence of stroke symptoms among persons without a diagnosis of stroke or transient ischemic attack in a general population: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

BACKGROUND: A substantial portion of the general population has clinically silent stroke on brain imaging. These lesions may cause symptoms. This study assessed the prevalence of stroke symptoms in a stroke- and transient ischemic attack (TIA)-free population and the association of symptoms with risk factors indexed by the Framingham Stroke Risk Score. METHODS: We performed a cross-sectional analysis from a randomly sampled national cohort enrolled from January 25, 2003, through November 30, 2005, with oversampling from the southeastern stroke belt and African American populations. The main outcome measure was stroke symptoms assessed by validated questionnaire. RESULTS: The study included 18 462 (41% African American; 51% female; mean age, 65.8 years) participants who reported no stroke or TIA. The prevalence of stroke symptoms was 5.8% for sudden painless hemibody weakness, 8.5% for sudden hemibody numbness, 4.6% for sudden painless loss of vision in one or both eyes, 3.1% for sudden hemifield visual loss, 2.7% for sudden inability to understand speech, and 3.8% for sudden inability of linguistic expression. The prevalence of 1 or more symptoms was 17.8%. Relative to the first quartile of the Framingham Stroke Risk Score, the adjusted odds ratio for 1 or more stroke symptoms increased from 1.0 (95% confidence interval [CI], 0.90-1.2) in the second quartile to 1.2 (95% CI, 1.1-1.5) and 1.5 (95% CI, 1.3-1.6) in successive quartiles. Symptoms were more prevalent among African American compared with white participants and among those with lower income, lower educational level, and fair to poor perceived health status. CONCLUSIONS: The general population without prior diagnosed stroke or TIA has a high prevalence of stroke symptoms. The relationship between symptoms and risk factors suggests that some symptomatic individuals may have had clinically undetected cerebrovascular events and may benefit from aggressive stroke prophylaxis.

Brain magnetic resonance imaging abnormalities following off-pump cardiac surgery.

BACKGROUND: Neurological and cognitive deficits are known complications after coronary artery bypass surgery (CABG) and are believed to be secondary to brain ischemia. Diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain is especially sensitive and can depict ischemic areas that may not be evident clinically or with conventional MRI. Abnormalities found at brain MRI following CABG performed with cardiopulmonary bypass (ie, on pump) have been reported, but data are limited for CABG performed without use of cardiopulmonary bypass (ie, off pump). The objective of this study was to determine the rate of DW-MRI detection of brain lesions following off-pump CABG. METHODS AND RESULTS: Sixteen patients consecutively undergoing off-pump CABG underwent DW-MRI prior to and after surgery. A neuroradiologist blinded to patient data coded the location and size of lesions. Neurological function was assessed with the National Institutes of Health Stroke Scale. Five (31%) of the patients had new focal ischemic lesions found at postoperative DW-MRI. Risk factors for postoperative brain ischemic lesions were similar between patients with and those without lesions found at DW-MRI. No patient had a definite clinical stroke after surgery. CONCLUSIONS: Ischemic lesions found at DW-MRI are seen after off-pump CABG at a rate similar to that reported for CABG with cardiopulmonary bypass. This finding suggests that these lesions are not totally due to cardiopulmonary bypass. Further prospective clinical studies would be helpful for determining which factors are causally related to brain ischemia following CABG.

Control of hypertension and risk of stroke recurrence.

BACKGROUND AND PURPOSE: We investigated whether low blood pressure increases the risk of stroke recurrence. METHODS: A cohort of 662 patients, obtaining care at the 8 acute care hospitals serving the Lehigh Valley in Pennsylvania, was enrolled within 1 month of an initial stroke and was followed twice annually for up to 4 years. Cox proportional hazard models were developed to examine the relationship between risk of recurrent stroke and blood pressure, controlling for other significant risk factors. Our analyses investigated both lowest follow-up and average follow-up blood pressures as predictors of stroke recurrence. RESULTS: There were 52 recurrent strokes among the 535 patients (mean age, 71 years; 51% men) with follow-up blood pressure. The risk ratio for stroke recurrence for diastolic blood pressure > or =80 mm Hg compared with <80 mm Hg was 2.4 (95% CI, 1.38 to 4.27) and for systolic blood pressure > or =140 mm Hg compared with <140 mm Hg was also 2.4 (95% CI, 1.39 to 4.15). For isolated systolic blood pressure (>140/<90 mm Hg), the risk ratio was 2.2 (95% CI, 1.23 to 3.79) relative to <140/<90 mm Hg. Using the Cox model, we also showed that patients who had at least 1 measured diastolic blood pressure <80 mm Hg during follow-up had a reduced risk of stroke recurrence compared with those with diastolic blood pressures 80 to 90 mm Hg (0.4 versus 1.0; 95% CI, 0.21 to 0.88) even after controlling for the possible confounding factors of hypertension and atrial fibrillation on ECG. Myocardial infarction on ECG, history of transient ischemic attack, and diabetes mellitus were not significant predictors of increased risk of recurrent stroke. CONCLUSIONS: Our results imply that "lower is better" for blood pressure control as a goal in reducing stroke recurrence risk.