Altitude headache.

High altitude headache (HAH) has been defined by the International Headache Society as a headache that appears within 24 hours after ascent to 2,500 m or higher [1••]. The headache can appear in isolation or as part of acute mountain sickness (AMS), which has more dramatic symptoms than the headache alone. If symptoms are ignored, more serious conditions such as high altitude cerebral edema (HACE), high altitude pulmonary edema (HAPE), or even death may ensue. While there is no definitive understanding of the underlying pathophysiologic mechanism, it is speculated that HAH occurs from the combination of hypoxemia-induced intracranial vasodilation and subsequent cerebral edema. There are a number of preventive measures that can be adopted prior to ascending, including acclimatization and various medications. A variety of pharmacological interventions are also available to clinicians to treat this extremely widespread condition.

Mexican Americans with atrial fibrillation have more recurrent strokes than do non-Hispanic whites.

BACKGROUND AND PURPOSE: Atrial fibrillation is a common cause of stroke with a known preventive treatment. We compared poststroke recurrence and survival in Mexican Americans (MAs) and non-Hispanic whites (NHWs) with atrial fibrillation in a population-based study. METHODS: Using surveillance methods from the Brain Attack Surveillance in Corpus Christi Project, cases of ischemic stroke/transient ischemic attack with atrial fibrillation were prospectively identified from January 2000 to June 2008. Recurrent stroke and all-cause mortality were compared by ethnicity with survival analysis methods. RESULTS: A total of 236 patients were available (88 MAs, 148 NHWs). MAs were younger than NHWs, with no ethnic differences in severity of the first stroke or proportion discharged on warfarin. MAs had a higher risk of stroke recurrence than did NHWs (Kaplan-Meier estimates of survival free of stroke recurrence risk at 28 days and 1 year were 0.99 and 0.85 in MAs and 0.98 and 0.96 in NHWs, respectively; P=0.01, log-rank test), which persisted despite adjustment for age and sex (hazard ratio=2.46; 95% CI, 1.19-5.11). Severity of the recurrent stroke was higher in MAs than in NHWs (P=0.02). There was no ethnic difference in survival after stroke in unadjusted analysis or after adjusting for demographic and clinical factors (hazard ratio=1.03; 95% CI, 0.63-1.67). CONCLUSIONS: MAs with atrial fibrillation have a higher stroke recurrence risk and more severe recurrences than do NHWs but no difference in all-cause mortality. Aggressive stroke prevention measures focused on MAs are warranted.

Hospital presentation after stroke in a community sample: the Mobile Stroke Project.

BACKGROUND: Existing data regarding time between stroke and presentation for treatment are largely derived from hospital-based or multicenter databases and may not accurately reflect presentation patterns for most hospitalized stroke patients. METHODS: We evaluated a consecutive series of all hospitalized patients in Mobile County, Alabama. RESULTS: We identified 1,010 hospitalized stroke patients. Of all patients with out-of-hospital stroke, 42% came to a hospital within 3 hours of symptom onset. There were no statistically significant interhospital differences. Being asleep at the time of stroke or being transported by family or friends significantly increased the likelihood of late arrival. CONCLUSIONS: A minority of stroke patients arrive at a hospital early enough to qualify for acute intervention. Until development of acute therapies with longer therapeutic windows or more robust therapeutic benefit than tissue plasminogen activator (t-PA), effective stroke prevention strategies will exert a greater influence on stroke incidence and morbidity.