Migraine in the Andes and headache at sea level.

In Cerro de Pasco (CP), Peru (altitude 4338 m) 24% of men have migraine with aura. We studied 30 men. Twenty CP natives, examined in CP, were rated using a chronic mountain sickness (CMS) score to separate controls (10) from those with CMS (10), a maladaptation syndrome in natives to altitude which includes severe, recurring headache. We collected white cells in CP and, from the same men, within 1 h of arrival in Lima (150 m above sea level). Ten normal US men volunteered white cells for comparison. After RNA extraction we assessed gene expression by reverse transcription-polymerase chain reaction. Low ATP1A1 subunit of the ATPase gene mRNA expression in CP was correlated with headache (P=0.002), acral paraesthesias (P=0.004) and CMS score (P<0.001). ATP1A1 subunit expression was increased in all Andeans in Lima (P<0.001). There were no differences between Andean controls in Lima and US controls. Manipulation of Na+/K+ATPase could offer relief for migraineurs at sea level.

Clinical features of spontaneous intracerebral hemorrhage in Hispanics and non-Hispanic Whites in New Mexico: a community study.

OBJECTIVES: To compare clinical features of spontaneous intracerebral hemorrhage (ICH) between Hispanics and non-Hispanic Whites in Albuquerque, New Mexico, occurring during the year 1993. DESIGN: Analysis of data collected during a study of ICH incidence in a community. METHODS: Review medical records with multiple relevant cerebrovascular diagnostic discharge codes in all 9 acute care hospitals in Albuquerque, and in the records of the State Medical Examiner. All suspected cases were verified by cerebral computed tomography or autopsy. Vascular risk factors, test results, and acute outcome were abstracted. RESULTS: There were 38 Hispanics and 46 non-Hispanic Whites with ICH. We found no statistically significant differences between these two ethnic groups in the prevalence of hypertension or diabetes mellitus, in hematoma volume, in seasonal fluctuation of ICH incidence, or in acute mortality. However, based on our sample size, only large differences in the prevalence of risk factors between these two ethnic groups could be detected with statistical significance (>20-30 percentage points). There was a trend toward a higher proportion of subcortical ICH (centered in the basal ganglia, brainstem, or cerebellum) in Hispanics (82%) than in non-Hispanic Whites (62%, P=.09). CONCLUSIONS: The higher proportion of subcortical ICH among the Hispanics suggests that chronic hypertension may play a greater role as a risk factor for ICH in this ethnic group than in non-Hispanic Whites in New Mexico. Our findings should be confirmed by larger community studies.

Risk factors for intracerebral and subarachnoid hemorrhage among Hispanics and non-Hispanic whites in a New Mexico community.

BACKGROUND AND OBJECTIVE: A higher incidence of spontaneous intracerebral and subarachnoid hemorrhage among Hispanics than non-Hispanic whites has been measured in Bernalillo County, New Mexico. In an attempt to explain these differences, we compared historical vascular risk factors between Hispanics and non-Hispanic whites living in this community. METHODS: An ongoing telephone survey, the Behavioral Risk Factor Surveillance System, collected annual data about vascular risk factors among non-institutionalized, randomly selected adults. Data covering 6 years, 1988-1993, were analyzed. RESULTS: There were 843 Hispanic and 1,635 non-Hispanic white residents of Bernalillo County, New Mexico, who participated in this survey. Because Hispanics were significantly younger than non-Hispanic whites (37.7 vs. 43.4 years, p < 0.001), all other comparisons were adjusted for age. Prevalence of hypertension was similar between these ethnic groups (15-17%). Prevalence of alcohol drinking considered risky for abuse was similar between these ethnic groups (5-6%), but was significantly higher among Hispanic men than women (8.5 vs. 1.6%, p < 0.001). The quantity of alcohol consumption among those at risk for abuse was similar between these ethnic groups. Prevalence of current cigarette smoking was similar between these ethnic groups (22-23%), but Hispanics smoked significantly less than non-Hispanic whites (11.4 vs. 15.2 cigarettes per day, p < 0.001) and among non-Hispanic whites, men smoked significantly more than women (17.0 vs. 13.4 cigarettes per day, p = 0.001). CONCLUSION: The vascular risk factors which we compared between Hispanics and non-Hispanic whites do not help to explain the higher incidence of hemorrhagic strokes among the Hispanics in Bernalillo County, New Mexico. Additional risk factors for hemorrhagic strokes in these two ethnic groups should be studied.

Incidence of spontaneous subarachnoid hemorrhage among Hispanics and non-Hispanic whites in New Mexico.

BACKGROUND AND PURPOSE: There are differences in cerebrovascular disease incidence between racial and ethnic groups. Little is known about cerebrovascular disease among Hispanics living in the southwestern United States as compared to non-Hispanic whites. This is the first study which measures and compares the incidence of spontaneous subarachnoid hemorrhage (SAH) among Hispanics and non-Hispanic whites living in Bernalillo County, New Mexico. This information may help reduce the risk and incidence of SAH. METHODS: Medical records of all possible cases of spontaneous SAH occurring during a two-year period (January 1, 1993 to December 31, 1994) among residents of Bernalillo County, New Mexico, were reviewed in all local hospitals. Hospital records were identified by ICD-9-CM codes. Medical examiner records were also reviewed for additional SAH cases occurring during the same time period. The 1990 U.S. census provided the population base. RESULTS: There were 22 spontaneous SAHs among 267,965 non-Hispanic whites and 25 spontaneous SAHs among 178,310 Hispanics. Incidence of SAH increased with age in both groups. The age- and sex-adjusted total annual incidence of SAH per 100,000 people was 3.73 among non-Hispanic whites and 9.19 among Hispanics (relative risk for Hispanics 2.46, 95% confidence interval 1.37-4.43, P = 0.003). The incidence rates among men and women were not significantly different in either ethnic group. CONCLUSIONS: The incidence of SAH among Hispanic residents of Bernalillo County, New Mexico, is approximately two and a half times higher than that among non-Hispanic whites. This suggests a higher prevalence or a greater tendency to rupture of berry aneurysms among Hispanics as compared to non-Hispanic whites. The reasons for this difference require further investigation.

Incidence of spontaneous intracerebral hemorrhage among Hispanics and non-Hispanic whites in New Mexico.

OBJECTIVE: To compare the incidence of spontaneous intracerebral hemorrhage (ICH) among Hispanics and non-Hispanic whites living in Bernalillo County, NM. BACKGROUND: There are differences in cerebrovascular disease incidence between racial and ethnic groups. Knowing these differences is likely to optimize stroke prevention and evaluation. METHODS: Medical records review of all possible cases of ICH occurring between January 1, 1993 and December 31, 1993 among residents of Bernalillo County, NM, in all local hospitals. Hospital records were identified by ICD-9-CM codes. Also, State Medical Examiner records review for additional ICH cases occurring during the same time interval. The 1990 U.S. census provided the population base. RESULTS: There were 47 spontaneous ICHs among 267,965 non-Hispanic whites and 39 spontaneous ICHs among 178,310 Hispanics. Incidence of ICH rises exponentially with age in both groups. The age- and sex-adjusted total annual incidence of ICH per 100,000 people is 16.6 among non-Hispanic whites and 34.9 among Hispanics (relative risk for Hispanics 2.10, 95% confidence interval 1.35 to 3.26, p = 0.001). The age-adjusted incidence rates among men and women are not significantly different in either ethnic group. CONCLUSION: The incidence of spontaneous ICH among Hispanic residents of Bernalillo County, NM, is approximately twice that among non-Hispanic whites. The reasons for this difference require further investigation.

Clinical features of ischemic stroke in Hispanics and non-Hispanic whites in New Mexico: a study of 341 consecutive patients at two hospitals.

This study was undertaken to determine whether there are any differences in the clinical features of ischemic stroke between Hispanics and non-Hispanic whites in New Mexico. From August 1988 to August 1990, one investigator prospectively evaluated consecutive patients who presented within 30 days of onset of stroke or transient ischemic attack and entered data into a computerized stroke registry. Several important vascular factors were recorded. Patients presented to either a Veterans Affairs Medical Center or a University Medical Center (a county facility). There were 112 Hispanics and 229 non-Hispanic whites with ischemic stroke or transient ischemic attack. Non-Hispanic whites were more likely to have ischemic heart disease (P = .01) and ischemic (vs nonischemic) causes of potential cardiogenic emboli (p = .05) than were Hispanics. The following were not significantly different between Hispanics and non-Hispanic whites: prevalence of vascular risk factors, death within 30 days of stroke, vascular territory involved, infarct location, prevalence of extracranial carotid stenosis, or cardiac sources of emboli. Our study does not show an obvious difference in the clinical features of ischemic stroke between Hispanics and non-Hispanic whites in New Mexico.

Asymmetric growth of the lateral cerebral ventricle in infants with posthemorrhagic ventricular dilation.

Lateral cerebral ventricular volume in 36 preterm infants with or without an intraventricular hemorrhage, and with or without posthemorrhagic hydrocephalus, was measured longitudinally and compared with the ventricular index measurements of the same ventricles. A poor correlation was found (r2 = 0.67). To determine a reason for this poor relationship, we analyzed the volumes of the regions of the ventricles by a segmental volume analysis. The occipital region of the lateral cerebral ventricle enlarged at a much faster rate (1.904 +/- 0.477 ml/day) than either the anterior region (0.546 +/- 0.253 ml/day; p less than 0.01) or the middle region (-0.209 +/- 0.334 ml/day; p less than 0.01) in infants with posthemorrhagic hydrocephalus. The rate of growth of the middle region of the lateral cerebral ventricles was the same for all infants. Linear indexes, such as the ventricular index and the lateral ventricular ratio, do not allow for accurate serial estimates of ventricular size in posthemorrhagic hydrocephalus because of asymmetric growth of the lateral cerebral ventricle. We conclude that sequential volume measurements are more useful than ventricular index measurements to follow ventricular size sequentially in infants with posthemorrhagic hydrocephalus.

Measurement of progressive cerebral ventriculomegaly in infants after grades III and IV intraventricular hemorrhages.

To develop guidelines that might help predict prospectively which infants with severe intraventricular hemorrhage (IVH) would require intervention, we obtained serial cranial sonograms to measure the rate of growth of cerebral ventricular volumes in 48 preterm infants with and without IVH. The infants were divided into three groups: (1) those with no IVH (22 infants), (2) those with IVH with acute ventricular dilation (13 infants), and (3) those with IVH with progressive ventricular dilation requiring intervention (13 infants). The decision to intervene because of progressive ventricular dilation was based on clinical criteria and the subjective assessment of increasing ventricular size on weekly cranial sonograms. The rate of cerebral ventricular volume growth in infants with IVH who needed intervention was greater (4.2 +/- 3.3 ml/day) than that in infants without IVH (0.0 +/- 0.1 ml/day; p less than 0.001) and in infants with IVH and acute ventricular dilation (0.0 +/- 0.2 ml/day; p less than 0.001). Using these data, we generated guidelines for predicting prospectively which infants with IVH and ventricular dilation will need intervention for posthemorrhagic hydrocephalus. The guidelines were then confirmed prospectively in 10 infants.