真性红细胞增多症致脑血管病25例临床诊治

目的探讨真性红细胞增多症(polycythemia vera,PV)致脑血管病的临床和影像学特点。方法对25例PV致脑血管病患者的临床资料进行回顾性分析。结果本组PV致脑血管病表现:头晕12例、眩晕5例,头痛8例、偏身肢体瘫痪15例、肢体麻木4例。脑梗死19例(76%),其中多发性脑梗死15例(60%);短暂性脑缺血发作2例(8%);脑出血2例(8%);蛛网膜下腔出血1例(4%);脑静脉窦血栓1例(4%)。均符合PV的临床表现和体征及血象、骨髓象改变。影像学检查显示以多发性小梗死灶多见(60%),常见于脑叶、基底节、内囊。脑出血血肿内密度不均匀,周边水肿明显。结论 PV致脑血管病以脑梗死多见,其中又以多发性脑梗死为主,并发脑出血、脑静脉窦血栓和蛛网膜下腔出血较少见。     

急性脑卒中后伴发全身炎症反应综合征的临床研究

目的探讨急性脑卒中患者全身炎症反应综合征(SIRS)的发生率。方法将338例急性脑卒中患者分为脑出血组(n=126)和脑梗死组(n=212)。采用构成比描述SIRS的发生率,比较各组的差别。结果急性脑卒中患者SIRS的发生率为51.8%,其中出血组的发生率(70.6%)显著高于梗死组(40.6%)(P0.01)。出血组中SIRS的发生率与脑出血量和临床表现严重程度呈正相关,梗死组SIRS的发生率与梗死面积大小呈正相关(P0.01)。结论急性脑卒中常并发SIRS。     

以脑卒中症状首发的原发真性红细胞增多症的特点

目的分析以脑卒中为首发症状的原发性真性红细胞增多症(PV)的临床特点。方法将22例以脑卒中首发的原发性PV患者的临床表现、CT/MRI和实验室检查特点分别与12例单纯原发PV和30例动脉硬化性脑梗死对比,并对其治疗反应和预后跟踪评价。结果①单纯PV组平均发病年龄为(34±8·5)岁,肝脾肿大发生率为66.7%(8/12),以脑血管病首发的PV组的平均发病年龄为(55±16·5)岁,肝脾肿大发生比例为4/22。②PV继发脑梗死常规治疗中脑梗死复发比例为9/19,单纯动脉硬化脑梗死组为1/30。③PV继发脑梗死中多发腔隙性脑梗死发生比例为12/19,有4/19合并了颅外其他部位梗死。结论①以脑血管病首发的PV年龄较大,肝脾肿大可不明显。②PV继发的脑梗死以腔隙性脑梗死最多见。③对治疗中反复发作的脑梗死应排查PV,红细胞比容应列为常规检查。④PV继发的脑梗死抗血栓常规治疗同时必须对PV治疗,血液稀释的同时放血。     

颅内外动脉并发狭窄导致的脑梗死模式

目的 探讨颅内外动脉并发狭窄导致的脑梗死的模式.方法 用CT血管成像(CTA)检测185例急性脑梗死患者的颅内外动脉的狭窄情况;MR弥散加权成像(DWI)检查确定患者的脑梗死模式:单发或多发性脑梗死,穿动脉梗死(PAI)、皮质支梗死(PI)、分水岭梗死(BZI)、大面积脑梗死.比较并发狭窄与非并发狭窄患者的脑梗死模式.结果 CTA示颅内外动脉并发狭窄69例,其中串联狭窄49例、非串联狭窄20例;非并发狭窄99例;无狭窄17例.颅内外动脉并发狭窄组的多发性脑梗死、PAI+ PI+ BZI的比率(55.1％,20.3％)显著高于非并发狭窄组(34.3％,5.1％)(均P＜0.01);而单发小PAI的比率(24.6％)显著低于非并发狭窄组(48.5％)(P＜0.01).并发狭窄组中串联狭窄亚组的多发性脑梗死(65.3％)及PAI+ PI+ BZI(26.5％)的比率显著高于非串联狭窄亚组(30％,5％) (P＜0.05 ～0.01);而单发小PAI的比率(14.3％)显著低于非串联狭窄亚组(50.0％)(P＜0.01).结论 颅内外动脉并发狭窄导致的脑梗死以多发性梗死及PAI+PI+BZI的模式多见.     

症状性后循环动脉狭窄患者的脑梗死模式研究

目的探寻症状性后循环动脉狭窄患者的脑梗死模式和脑卒中机制。方法发病后48 h内行MR弥散成像(DWI)证实在椎基底动脉(VBA)供血区有急性梗死灶的患者,根据患者病史、临床特征结合头颈部血管成像检查,按相关标准分为动脉粥样硬化组和心源性脑栓塞组,并对两组的脑梗死模式进行比较。结果共收集症状性后循环脑梗死患者115例,其中动脉主干狭窄>50%的脑梗死患者58例(50.4%),心源性脑栓塞患者10例(8.7%)。动脉粥样硬化组最常见狭窄部位是椎动脉V4段(51.7%),其次是基底动脉中段及VBA接合处(41.4%)。多发性梗死在动脉粥样硬化组和心源性脑栓塞组分别为60.3%和70%(P=0.820);双侧梗死在两组分别为43.1%和50%(P=0.951);基底动脉终末支的远端梗死在两组分别为50%和70%(P=0.408)。结论后循环动脉病变以颅内段为主;多发性梗死是后循环动脉狭窄患者脑梗死的重要特征;动脉-动脉性栓塞是多发性脑梗死患者脑卒中的重要病理机制。     

成人贫血并发急性脑梗死的临床特点分析

目的 探讨成人贫血并发急性脑梗死的临床特点。方法 回顾性分析2014年1月～2015年12月本院神经内科收治的18例成人贫血并发急性脑梗死患者的临床资料,总结其贫血特点、脑卒中危险因素、临床表现和脑MRI特点。结果 成人贫血并发急性脑梗死患者占同期所有住院急性脑梗死患者(205例)的比例为8.78%。其中男11例,女7例,平均年龄(60.56±12.50)岁(35～87岁),平均血红蛋白浓度(74.06±14.95)g/L(52～102 g/L); 轻度贫血3例(16.66%),中度贫血12例(66.67%),重度贫血3例(16.66%); 平均血小板计数(311.33±101.48)×10⁹/L(136～455×10⁹/L); 小细胞低色素性贫血14例(77.78%)(9例确诊为缺铁性贫血),缺铁性贫血患者平均血小板计数(375±73.78)×10⁹/L(251～455×10⁹/L)。无脑卒中危险因素者6例(33.33%),脑卒中危险因素1～2项者7例(38.89%),3项以上危险因素者5例(27.78%); 5例有意识障碍(27.78%); 12例病灶累及前循环(66.67%),14例累及分水岭区(77.78%),10例累及放射冠及半卵圆中心(55.56%); 13例为多发性脑梗死(72.22%),15例为小梗死(83.33%)。18例患者均行扩容治疗,4例输注红细胞; 临床治愈及好转者12例(66.67%)。结论 成人贫血并发急性脑梗死患者多为中度贫血,缺铁性贫血占多数,多伴有继发性血小板增多; 患者多缺乏脑血管病危险因素; 病变多位于脑前循环分布区,分水岭区多见,病灶以多发性小梗死灶为主,且多累及放射冠及半卵圆中心。治疗应以扩容及纠正贫血为主。     

DWI联合SWI在急性自发性微量脑出血的临床研究

目的探讨磁共振弥散加权成像(DWI)联合磁敏感加权成像(SWI)在急性自发性微量脑出血中的诊断价值及与急性脑梗死的区别。方法急性脑血管病患者57例,其中自发性微量脑出血25例(微出血组),脑梗死32例(脑梗死组)。所有患者行常规头颅MRI、SWI、DWI序列扫描,分析微出血组以及脑梗死组在各序列上的影像学特点,统计各序列对出血灶或梗死灶的检出率,比较2组间血肿中心的ADC值及PW值,进行统计分析。结果微出血组在SWI上血肿呈类圆形低信号或者类圆形低信号混杂点状高信号影,周围见高信号,与其他MRI序列相比,SWI序列对出血灶的检出率最高。脑梗死组在DWI表现为显著高信号,且边缘清晰,与其他序列比较,DWI序列对梗死灶的检出率最高。脑梗死组血肿中心的ADC值及PW值均明显高于微出血组(P0.05)。结论 SWI对急性自发性微量脑出血的诊断准确性最高,几乎无漏诊。DWI对脑梗死的诊断具有明显的特异性及准确性。DWI联合SWI能有效诊断急性微量脑出血,并能与梗死后的微量脑出血相鉴别,能合理指导临床治疗。     

急性心肌梗死并脑卒中34例临床分析

目的 探讨急性心肌梗死(AMI)与脑卒中的关系,为临床预防及治疗提供依据.方法 总结AMI并发脑卒中临床病历资料,采用回顾性分析方法对AMI并发脑卒中的类型、诊治经过及预后进行总结.结果 428例AMI并发脑卒中34例(7.9%),其中脑梗死32例;蛛网膜下腔出血1例;脑出血1例.34例共死亡7例(20.6%).结论 ...     

颈椎手术后并发脑梗死或脑出血的DWI及SWI特点分析

目的探讨颈椎手术后并发脑梗死、脑出血磁共振弥散加权成像(DWI)和磁敏感加权成像(SWI)的影像学特点。方法选取郑州市骨科医院2010-01—2015-12行颈椎手术后并发脑梗死37例和脑出血14例患者,采用GE 1.5T磁共振,全部常规行MRI、DWI、SWI扫描,对比分析图像特点。结果颈椎术后并发脑梗死,DWI序列显示为均匀高信号影;SWI序列显示为等信号影,如有继发性出血,SWI序列可见到小斑点状的低信号影。颈椎术后并发脑出血,DWI序列显示出血中心为低信号影,周围可见稍高信号水肿区;SWI出血中心显示为均匀斑片样低信号影,周围可见高信号水肿区。定量分析颈椎术后(≤6 h、7～12 h和13～24 h)3个时间点出血区表现的弥散系数(ADC)值:(3.66±1.05)×10~(-4)、(3.73±0.68)×10~(-4)、(3.79±0.85)×10~(-4);梗死区ADC值:(6.23±1.13)×10~(-4)、(5.80±2.05)×10~(-4)、(4.86±0.85)×10~(-4),颈椎术后出血区ADC值低于梗死区ADC值,差异有统计学意义(P0.05)。3个时间点颈椎术后出血区相位(PV)值:—0.70、—0.70、—0.71,梗死区(PV)值:—0.33、—0.34、—0.32,出血区低于梗死区PV,差异有统计学意义(P0.05)。结论根据颈椎术后脑梗死、脑出血DWI、SWI序列的影像学表现特点不同,行快速诊断及鉴别,对临床诊断、病情监测、指导治疗及预后有重大的意义。     

急性脑梗死SWI低信号与血脑屏障完整性对于出血性转化的早期判断

目的研究急性脑梗死病例磁敏感加权成像(susceptibility weighted imaging,SWI)低信号与对比增强磁共振成像(contrast-enhanced MRI,CE-MRI)之间的关系,判断其性质及发生机制,比较两者评价脑出血的能力。方法分析2012年8月²013年11月我院收治的86例急性脑梗死患者的影像资料,统计梗死区内SWI低信号与CE-MRI强化的病灶数目,评价其信号表现特点。结果 SWI与CE-MRI检出脑出血的敏感度均为100%,特异度分别为86.17%、87.10%。SWI低信号除为出血外(17个),还可能为脑微出血(8个)、梗死灶的引流静脉(3个)及陈旧性出血灶(2个)。CE-MRI出现强化的病灶共29个,其中17个为出血灶。结论 SWI与CE-MRI对急性脑梗死后出血的敏感度都很高,特异度也相当,但两者对其诊断能力不同。SWI会出现假阳性现象;而CE-MRI对脑出血的提示早于SWI,可于出血发生前判断血脑屏障的完整性,甚至预测出血性转化的发生,两者结合可更准确地判断梗死后出血。     

Cerebral arterial dissection]

We investigated a total of 98 cases with stroke caused by cerebral arterial dissection recruited in Strategies against Stroke Study for Young Adults in Japan (SASSY-Japan). The most frequent site of dissection was the intracranial vertebrobasilar artery. The stroke subtype was divided into ischemic (TIA and cerebral infarction) and hemorrhagic types (subarachnoid hemorrhage). The ischemic type was predominant (69%) and patients with the ischemic type were younger than those with the hemorrhagic type (P < 0.01). In the intracranial arterial dissection, nearly all cases were of the ischemic type. In contrast, in the extracranial arterial dissection, 60% of cases were ischemic and 40% were hemorrhagic. Cerebral angiography was the most important diagnostic procedure in the hemorrhagic type. In the ischemic type, MRI and MRA were more frequently used to show the findings specific to the dissection such as an intimal flap or double lumen and intramural hematoma. The outcome at discharge is generally good such that the modified Rankin Score was among 0-II in 69% of cases. However, in the hemorrhagic type, recurrence during an acute stage was frequent, and the outcome was poor with a mortalit rate of 19%. The establishment of an effective intervention to prevent the recurrence of subarachnoid hemorrhage is urgently required.     

Trends of stroke subtypes mortality in Sao Paulo, Brazil (1996-2003)

The decline of stroke mortality rates has been described in Brazil; however, there is no data about stroke subtypes. We described the changes of stroke mortality rates in the city of Sao Paulo (1996-2003) emphasizing intracerebral hemorrhage and cerebral infarction. We categorized mortality data by gender and 10-year age-strata from 30 to 79 years-old. For men, an annual reduction of all types of stroke (-3.9%), and of stroke subtypes as intracerebral hemorrhage (-3.0%) and cerebral infarction was observed (-2.7%) as well as, a decline of ill-defined stroke (-7.4%). For women, a decline was observed for all types of stroke (-3.3%) and for ill-defined stroke (-12%). However, the switch of ill-defined cases to stroke subtype categories due to a better clinical diagnosis blurred a real decline of both cerebral infarction and intracerebral hemorrhagic stroke among women.     

in-hospital mortality in patient with acute ischemic and hemorrhagic stroke

There is a lack of evidence to compare in-hospital mortality with different types of stroke. The purpose of this study was to elucidate the in-hospital mortality after acute ischemic/hemorrhagic stroke and compare the factors associated with the mortality among stroke subtypes. All patients admitted to Kurashiki Central Hospital in Japan between January 2009 and December 2009, and diagnosed with acute ischemic/hemorrhagic stroke were included in this study. Demographics and clinical data pertaining to the patients were obtained from their medical records. Out of 738 patients who had an acute stroke, 53 (7.2%) died in the hospital. The in-hospital mortality was significantly lower in the cerebral infarction group than in the intracerebral hemorrhage and subarachnoid hemorrhage group (3.5%, 15.1%, and 17.9%, respectively; P<0.0001). Age was significantly lower in the subarachnoid hemorrhage group than in the other 2 groups. With regard to past history, diabetes mellitus was significantly found to be a complication in mortality cases of intracranial hemorrhage. Further investigation is needed to clarify the effect of diabetes on mortality after intracranial hemorrhage.     

Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants

BACKGROUND AND PURPOSE: Blood pressure is an important risk factor for stroke, but the roles of serum total and HDL cholesterol, alpha-tocopherol, and beta-carotene are poorly established. We studied these factors in relation to stroke subtypes. METHODS: Male smokers (n=28 519) aged 50 to 69 years without a history of stroke participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, a controlled trial to test the effect of alpha-tocopherol and beta-carotene supplementation on cancer. From 1985 to 1993, a total of 1057 men suffered from primary stroke: 85 had subarachnoid hemorrhage; 112, intracerebral hemorrhage; 807, cerebral infarction; and 53, unspecified stroke. RESULTS: Systolic blood pressure > or = 160 mm Hg increased the risk of all stroke subtypes 2.5 to 4-fold. Serum total cholesterol was inversely associated with the risk of intracerebral hemorrhage, whereas the risk of cerebral infarction was raised at concentrations > or = 7.0 mmol/L. The risks of subarachnoid hemorrhage and cerebral infarction were lowered with serum HDL cholesterol levels > or = 0.85 mmol/L. Pretrial high serum alpha-tocopherol decreased the risk of intracerebral hemorrhage by half and cerebral infarction by one third, whereas high serum beta-carotene doubled the risk of subarachnoid hemorrhage and decreased that of cerebral infarction by one fifth. CONCLUSIONS: The risk factor profiles of stroke subtypes differ, reflecting different etiopathology. Because reducing atherosclerotic diseases, including ischemic stroke, by lowering high serum cholesterol is one of the main targets in public health care, further studies are needed to distinguish subjects with risk of hemorrhagic stroke. The performance of antioxidants needs confirmation from clinical trials.     

急性卒中并发上消化道出血单中心初步调查结果

目的 调查急性卒中并发上消化道出血的发病情况。方法 选取北京天坛医院中国急性脑血管病事件登记（Registry of Acute Cerebrovascular Events in China,RACE-CHINA）的急性卒中住院患者,对其住院病史记录进行回顾性分析。结果 2007年8月至2008年7月,北京天坛医院RACE－CHINA共登记急性卒中患者1408例,确诊上消化道出血40例,急性卒中上消化道出血的发生率为2.84%,上消化道出血患者平均年龄63±9岁,脑出血患者上消化道出血的发生率略高于脑梗死和蛛网膜下腔出血患者（2.98%：2.75%,2.98%：2.84%）,意识障碍患者、脑出血量大者、椎基底动脉系统脑梗死更易发生上消化道出血。上消化道出血多发生在卒中后第1～2周,持续时间多在1周内。急性卒中总体死亡率为7.0%,出现上消化道出血后,卒中死亡率为30%。结论 上消化道出血是急性卒中的严重并发症,年龄、性别、卒中类型、出血量、意识状态等可能是其主要危险因素,临床上应高度重视,加强防治。     

Stroke complicating pregnancy and the puerperium

Stroke complicating pregnancy and the puerperium in Taiwan and the comparison between Western and Eastern countries have not been well studied. We identified retrospectively 32 cases of stroke from 66 781 deliveries, including 21 intracranial hemorrhages and 11 cerebral infarctions from 1992 to 2004. The most common causes of intracranial hemorrhage were vascular anomaly (29%), pre-eclampsia/eclampsia (24%), undetermined (24%) and coagulopathy (19%). The most common causes of cerebral infarction were cardioembolism (36%), cerebral venous thrombosis (27%) and pre-eclampsia/eclampsia (18%). Perinatal adverse outcome included two stillbirths, nine premature deliveries and four abortions. The compiled results of previous studies and ours revealed that intracranial hemorrhage appeared to be slightly more common in Taiwan (43–69%) than in the Western countries (33–52%). The average maternal mortality rate was 17.8% (range 9–38) with 77.8% due to intracranial hemorrhage. The average incidence of stroke associated with pregnancy and the puerperium was 21.3 per 100 000 deliveries (range 8.9–67.1). Our study, different from the Western countries, showed that intracranial hemorrhage is slightly more common than cerebral infarction. Pre-eclampsia/eclampsia is an important cause of stroke, however, the possibility of cardioembolism in cerebral infarction and vascular anomaly in intracranial hemorrhage should be studied.     

脑卒中后早期癫痫发作的发生率及其相关因素分析

目的研究脑卒中后2周内癫痫发作的发生率及其相关因素。方法回顾性分析1062例急性脑卒中患者发病后2周内癫痫发作的发生率、发作类型、病死率及癫痫与脑卒中类型、病灶部位的相关性。结果急性脑卒中发病后2周内早期癫痫发作的发生率为5．7%,其中以蛛网膜下腔出血后癫痫发作的发生率最高(9．6%);部分性癫痫发作多发生于缺血性卒中,而出血性卒中以全面性癫痫发作好发。无论病变性质如何,皮质损害的患者易导致早期癫痫发作。结论脑卒中后早期癫痫发作很常见,其发生率与卒中类型及病变部位相关。     

卒中类型、卒中部位与卒中后癫痫的多因素关系

目的探讨卒中类型、卒中部位与卒中后癫痫的多因素关系,为卒中后癫痫的防治提供参考。方法以1804例卒中患者为研究对象,收集其性别、年龄、卒中类型、卒中部位、卒中后癫痫发生的时间等资料,根据卒中后是否发生癫痫,将患者分为卒中后无癫痫组(n=1487)和卒中后癫痫组(n=317),分析卒中后癫痫发作的危险因素。结果共317例卒中后癫痫发作患者,其中早发性癫痫141例(44.48%),迟发性癫痫176例(55.52%)。不同卒中部位及卒中类型的癫痫发病率为17.57%。多因素logistic回归分析显示,卒中部位中的顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶是卒中后发生癫痫的危险因素(P<0.01),其中单一颞叶是卒中后早发性癫痫的危险因素(P<0.01)。脑梗死患者常见早发性癫痫(23.66%),脑出血患者常见迟发性癫痫(47.95%)。结论卒中类型中的脑梗死、脑出血、蛛网膜下腔出血与卒中后癫痫有关;卒中部位中顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶与卒中后癫痫有关。     

Stroke in Saudi Arabian young adults: a study of 120 cases

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.     

Vitamin E and beta carotene supplementation in high risk for stroke: a subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study

CONTEXT: High serum or dietary levels of vitamin E and beta carotene appear to be associated with lower risk of stroke, but studies regarding their supplementation have not supported their use in stroke prevention. OBJECTIVE: To determine if vitamin E (dl-alpha tocopherol) and beta carotene supplementations could be used in prevention of stroke in men at high risk for hemorrhagic or ischemic events. DESIGN: Population-based, randomized, double-blind, placebo-controlled, 2 x 2 factorial design trial (the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study), conducted from April 1985 through April 30, 1993, with median follow-up of 6 years. INTERVENTIONS: Alpha tocopherol, 50 mg; beta carotene, 20 mg; both; or placebo. PARTICIPANTS: From the total male population aged 50 through 69 years in southwestern Finland (n = 290,406), 29,133 male smokers were randomized to 1 of 4 treatment regimens. We excluded 614 men because of previous stroke at baseline, leaving 28, 519. MAIN OUTCOME MEASURES: Incident and fatal subarachnoid and intracerebral hemorrhage, cerebral infarction, and unspecified stroke. RESULTS: Stroke occurred in a total of 1057 men: 85 had subarachnoid and 112 had intracerebral hemorrhage, 807 had cerebral infarction, and 53 had unspecified stroke. Within 90 days from onset, 160 men died of stroke. Vitamin E supplementation increased the risk of subarachnoid hemorrhage (relative risk [RR], 2.45; 95% confidence interval [CI], 1.08-5.55) and decreased risk of cerebral infarction (RR, 0.70; 95% CI, 0.55-0.89) in hypertensive men but had no effect among normotensive men. Furthermore, it decreased the risk of cerebral infarction, without elevating the risk of subarachnoid hemorrhage, among hypertensive men with concurrent diabetes (RR, 0.33; 95% CI, 0.14-0.78). Beta carotene supplementation appeared to increase the risk of intracerebral hemorrhage and modestly decrease that of cerebral infarction among men with greater alcohol consumption. CONCLUSION: Vitamin E supplementation may prevent ischemic stroke in high-risk hypertensive patients, but further studies are needed. Arch Neurol. 2000;57:1503-1509