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Limited information exists on the frequency, trends in occurrence, risk factors, mechanisms, and outcome of ischemic stroke associated with illicit drug use among young adults in a geographically defined population.

To gain insight into the historical features relevant to the diagnosis of cardiac embolie strokes, we studied the 1,290 patients with cerebral infarcts in the NINCDS Stroke Data Bank. Based solely on the presence of cardiac sources of embolism, we divided the patients into groups of high (n 250), medium (n 166), and low (n 874) risk of a cardiogenic mechanism for their stroke. There was a highly significant graded relationship between increasing risk of a cardiac source and a history, or presence of, systemic embolism, abrupt onset, and diminished level of consciousness at onset. These clinical features may be useful for assessing the likelihood of a cardiac embolie mechanism in patients with cerebral infarcts.

The Baltimore-Washington Cooperative Young Stroke Study is the largest biracial urban-suburban population-based study to examine the etiology of strokes in children.

Baseline neuropsychological function was assessed in 2,123 Framingham Heart Study participants and was related to mortality over an 8- to 10-year follow-up period. During that time, 573 persons died. Using Cox proportional hazards models, the authors showed poor cognitive function to be consistently associated with an increased risk of death. This association persisted after adjustment for the confounding effects of age, education, and illness. Subjects scoring below the 26th percentile of performance were at increased risk of mortality compared with high scorers (the relative risk was 1.3 for the 11th percentile-25th percentile and 1.7 for the 1st percentile-10th percentile).

Few reports on stroke in young adults have included cases from all community and referral hospitals in a defined geographic region.

To gain insight into neurologic signs relevant to the diagnosis of cardiogenic embolism, we analyzed data from 1,290 patients with cerebral infarcts in the NINDS Stroke Data Bank. Based solely on the presence of potential cardiac sources of embolism, we divided patients into groups of high (N 250), medium (N 167), and low (N 873) risk of a cardiogenic mechanism for their stroke. Diminished level of consciousness was highly associated with the presence of a cardiac source of embolism. Of the four primarily cortical deficits assessed, three (visual field abnormalities, neglect, and aphasia) showed a highly significant graded relationship to the cardiac risk groups. For the fourth cortical deficit (other nonlanguage cognitive functions), this relationship did not attain statistical significance. Conversely, hemiparesis without sensory or cortical deficits had a strong inverse association to the presence of a cardiac source of embolism. This inverse association was weaker for sensorimotor strokes and nonexistent for pure sensory strokes. Although some neurologic findings had highly significant associations with the presence of a cardiac source of embolism, their predictive value for an embolic source was low.

The relationship of alcohol consumption, measured in 1965-1968 by the 24-hour recall method, to incident coronary heart disease morbidity at eight years and mortality at 12 years of follow-up was investigated in a cohort of 9150 Puerto Rican males 35-79 years of age. After adjustment for age, cigarettes, exercise, urban/rural status, and income, there was clear evidence of a "U-shaped" relationship between alcohol and total mortality, and also the suggestion of a "J-shaped" relationship for angina pectoris, nonfatal myocardial infarction, and nonsudden coronary heart disease death. There was no association of alcohol with sudden cardiac death. The adjusted odds ratio for drinkers versus nondrinkers was 0.6 for angina pectoris (p less than 0.05), 0.7 for nonfatal myocardial infarction (p less than 0.1), and 0.7 for nonsudden coronary heart disease death (p less than 0.05). The inverse association of alcohol consumption to nonsudden coronary heart disease death was found to be dependent on age and income: the adjusted odds ratio for subjects under age 60 (0.4) or over the median income (0.3) strongly favored drinkers, while there was no evidence for a "protective effect" of alcohol consumption in the older and poorer segments of the population. It is concluded that available evidence does not justify the assertion that the inverse association between moderate alcohol intake and coronary heart disease risk is a causal one.

In 1976-1978, a battery of eight neuropsychologic tests were administered to 2,123 participants in the Framingham Study who were aged 55-89 years. Performance on each test was examined in relation to concurrently measured systolic and diastolic blood pressure while controlling for age, sex, education, antihypertensive medication, alcohol consumption, and smoking. Those with a diagnosis of stroke were excluded from the analysis. In the remaining sample of 2,032, neither blood pressure nor antihypertensive treatment was significantly associated with cognitive performance. Even after excluding persons on antihypertensive medication, blood pressure was still unrelated to cognitive performance. In contrast to other studies, the authors found no consistent relation between blood pressure and cognitive performance.