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Of 123 survivors of documented completed stroke from the Framingham Cohort, 119 received objective evaluations of functional status along with an equal number of controls matched for age and sex. Of the stroke survivors, 16 per cent were institutionalized, 31 per cent dependent in self-care, and 20 per cent dependent in mobility. In addition, 71 per cent had decreased vocational function, and 62 per cent decreased socialization outside the home. Each of these frequencies was significantly greater than the corresponding rate in the control group. (N Engl J Med 293:954–956, 1975)

Risk of cerebral infarction over 16 years was ascertained in 5,185 men and women classified according to their hemoglobin, blood pressure and cigarette habit on entry to the Framingham Study. Within the normal range of hemoglobin values, risk was found to be proportional to the blood hemoglobin concentration in both sexes. Men with hemoglobin values of 15 gm or greater and women with 14 gm or more had twice as many cerebral infarctions as did their cohorts with lower values. The risk of initial development of 82 cerebral infarctions was also strikingly related to antecedent blood pressure status in both sexes and to the cigarette habit in men. When allowance is made for associated blood pressure and cigarette habit--factors found to correlate with both blood hemoglobin values and incidence of cerebral infarction--hemoglobin level had only a modest residual effect, no longer statistically significant. The pathogenetic, preventive and therapeutic implications of the interrelationship of blood hemoglobin, blood pressure and the cigarette habit and their association with cerebral infarction require further exploration.

Of 17 healthy adults without nystagmus who ingested 100 mg of pentobarbital sodium, six had up-beating, gaze-evoked vertical nystagmus 12 hours later. Three of them had nystgmus 36 hours later, but none of them had it 60 hours later. Therefore, one should be reluctant to ascribe this type of nystagmus to a disease of the central nervous system in patients who received a barbiturate within several days of examination.

THE purpose of this report is to call attention to a pupillary sign of dominantly inherited amyloidosis. We encountered the sign, reported in 1952 by Andrade,1 in one of two brothers who were alrea...

Review of the epidemiology of atherothrombotic brain infarction (ABI) based largely on 18 years of prospective data from the Framingham cohort reveals that stroke is a potent force in morbidity and mortality, that hypertension is its dominant precursor, that it can be predicted and suggests that only a preventive approach can substantially reduce stroke morbidity. Data from Framingham on the relative frequency of the major types of stroke found in the community reveal that 57 percent are due to ABI and only 17 percent to intracranial hemorrhage--two-thirds of which is subarachnoid. Lacunar infarcts are common accounting for 13 percent of ABI's in men and 23 percent in women. Despite the sizeable geographic, seasonal and secular trends in stroke mortality, few environmental determinants of stroke have been uncovered. However, established hallmarks of the candidate for an atherothrombotic stroke include: hypertension (systolic or diastolic), glucose intolerance, high normal hemoglobin, the cigarette habit (men only), abnormal lipids (under age 60) and cardiac impairments. Many unresolved issues remain. Nevertheless, it is possible to identify a tenth of the general population from which half the strokes will emerge. This provides a rational basis for establishing a program of prevention.

Control of hypertension, labile or fixed, systolic or diastolic, at any age, in either sex appears to be central to prevention of atherothrombotic brain infarction (ABI). Prospectively, hypertension proved the most common and potent precursor of ABI's. Its contribution was direct and could not be attributed to factors related both to stroke and hypertension. Asymptomatic, causal "hypertension" was associated with a risk of ABI about four times that of normotensives. The probability of occurrence of an ABI was predicted no better with both blood pressure measurements or the mean arterial pressure than with systolic alone. Since there was no diminishing impact of systolic pressure with advancing age, the concept that systolic elevations are, even in the aged, innocuous is premature. Comparing normotensives and hypertensives in each sex, women did not tolerate hypertension better than men.