The incidence and mortality rates of cerebrovascular disease (CVD) before age 55 were estimated for the Stockholm county between 1973 and 1977 using community based diagnosis and death statistics registers. Annual validation procedures concluded that less than 5% of hospitalized patients may have escaped registration. During the study period a diagnosis of CVD (initial stroke or TIA) was reported in 2,103 individuals, giving annual average crude incidence rates for stroke and TIA of 34 and 4 respectively per 100,000 inhabitants under age 55. Hemorrhagic lesions were reported in 45.4% of the cases, ischemic lesions in 33.1% and unclassified lesions in 21.5%. For all diagnostic categories a strong correlation to age is found, and for most categories the male:female ratio is high. The mortality rates are high for hemorrhagic lesions and low for ischemic and unclassified lesions. Incidence rates are higher than in Uppsala and Gothenburg, Sweden, but lower than in North Karelia, Finland. Mortality rates are similar to those reported by most other investigators.

The etiological characteristics of cerebrovascular disease (CVD) before the age of 55 are reviewed in 399 patients admitted to the Department of Neurology, Karolinska Hospital, Stockholm, from 1973-77. The material was well-defined with regard to subtypes of stroke as well as to the diseased population. The control material consists of 829 males and females of corresponding age randomly selected from the Stockholm population. In the ischemic group, 61% had angiographic evidence of atherosclerosis and, compared to controls, in most patient groups a significant (P less than 0.05-0.001) association with hypertension, diabetes, heart disease and smoking was found as well as for female patients under age 40 the use of oral contraceptives (P less than 0.001). In the hemorrhagic group, angiography demonstrated aneurysms in 76% of the patients with subarachnoidal bleeding but also atherosclerotic lesions in about 12% of the whole group. This would imply that atherosclerosis is an important precursor also for hemorrhagic lesions, further supported by a significant (P less than 0.01-0.001) association of hypertension, diabetes and smoking with this group.

Acta Neurologica ScandinavicaVolume 65, Issue S90 p. 172-172 IS THE STROKE INCIDENCE INCREASING IN SWEDEN? P. Lindström, P. Lindström Department of Neurology Karolinska Hospital, Stockholm, Sweden.Search for more papers by this authorC-E Söderström, C-E Söderström Department of Neurology Karolinska Hospital, Stockholm, Sweden.Search for more papers by this authorK.L. Mettinger, K.L. Mettinger Department of Neurology Karolinska Hospital, Stockholm, Sweden.Search for more papers by this author P. Lindström, P. Lindström Department of Neurology Karolinska Hospital, Stockholm, Sweden.Search for more papers by this authorC-E Söderström, C-E Söderström Department of Neurology Karolinska Hospital, Stockholm, Sweden.Search for more papers by this authorK.L. Mettinger, K.L. Mettinger Department of Neurology Karolinska Hospital, Stockholm, Sweden.Search for more papers by this author First published: March 1982 https://doi.org/10.1111/j.1600-0404.1982.tb03437.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume65, IssueS90March 1982Pages 172-172 RelatedInformation

The diagnostic value of positron emission tomography (PET) was evaluated in 41 examinations of 40 patients. 68Ga-EDTA was used as a positron source. The findings were correlated with those of conventional of CT scanning. A clearly pathologic accumulation of 68Ga-EDTA was detected in 29 of 41 PET scans. The precontrast CT scans were negative in 11 and non-conclusive in one patient. CT after administration of contrast medium was performed in 29 patients. Of these, 21 had a clearly pathologic PET scan and 14 had visible contrast enhancement on CT examination. The injury of the blood-brain barrier thus was better demonstrated with PET than with CT. The topologic diagnosis was, however, better demonstrated at CT. It seems that CT and PET are supplementary examinations and that PET is superior to CT in the detection of injury of or absence of the blood-brain barrier.

In 52 patients under the age of 55 with verified ischemic cerebrovascular disease parameters of blood coagulation, platelet function and fibrinolysis were measured at a stage after the onset of disease when the acute phase reactions are presumed to have elapsed. The total material was compared to a control material of healthy men and women of corresponding age.

Computer tomography (CT) and spectrophotometry of CSF were performed in 30 patients with the clinical diagnosis of cerebral concussion or contusion. The patients with concussion all had normal CT-findings. Spectrophotometry of CSF was sometimes positive for cerebral contusion with normal CT-findings, but the two methods were complementary so that the extent of the lesion was determined by CT and spectrophotometry of CSF indicated the cause.

Serum-lipoproteins were determined in male and female patients aged under 55 who had survived an attack of ischaemic cerebrovascular disease (I.C.D.). The results were compared with findings in healthy controls. Total serum triglyceride and cholesterol concentrations were not increased. However, in the very-low-density lipoprotein fraction increased cholesterol concentrations were found, and the mean value of high-density-lipoprotein (H.D.L.) cholesterol in I.C.D. patients was 18% lower than in controls. Since a low H.D.L.-cholesterol concentration has been suggested as an independent strong risk factor, it is possible that the susceptibility of I.C.D. patients to atherosclerosis is the result of a low H.D.L. rather than hyperlipoproteinaemia.

Fifty-seven cases admitted to the Karolinska Hospital 1973-1976 with the diagnosis transient cerebral ischemia were reviewed. Seventeen cases were excluded as not fulfilling the strict TIA definition. An analysis of the records and the supplementary questionnaire of the remaining cases showed considerable sex differences in the stroke-prone profile. In the male group arteriosclerosis in the extracranial cerebral arteries was demonstrated in 90% of these examined by angiography. In the female group factors recognized as interfering with the coagulation system were obvious in more than 70% and two women had fibromuscular dysplasia. These differences may have therapeutic and prognostic implications. In the total material only 35% had hypertension. Diabetes was not present in any of the patients. Of the men 46.6% had abnormal blood lipids against 15.4% of the women. Seventy-five percent of the patients with verified arteriosclerosis were regular smokers. At a mean follow-up time of 18.7 months only one patient, in the untreated group, developed completed stroke.

Combined examinations with quantitative CSF spectrophotometry (CSF-SPE) and computer tomography (CT) were performed on 53 patients with traumatic head injuries. In cerebral concussion the results were mainly normal in both examinations. In cerebral contusion bleeding patterns were found by CSF-SPE in all subjects, with a special bleeding pattern (S2 pattern) occurring in 86%. CT showed findings described as typical for contusion in 8 of 14 examined patients, the remaining CT scans showing questionable or normal signs. In extra- and intracerebral haematomas, all patients had bleeding patterns on the CSF-SPE. A special bleeding component (H factor) was found in about 72%. The H component was not observed during the first 3 to 4 days after the trauma. All but one patient examined later than the 4th day had an H component with or without an S-pattern. CT demonstrated a haematoma in 14 of 18 verified haematoma patients, while 4 subjects with subdural haematoma (e.g. one third of this group) had questionable CT findings. The combined examinations with CT and CSF-SPE, being complementary to each other, are of great value in the different diagnosis of traumatic head injuries.

Serum lipoproteins were determined 8–12 weeks after the onset of ischemic cerebro-vascular disease (ICD) in 61 patients, 38 males and 23 females, before the age of 55. The results were compared with those of a matched control material. The diagnosis was based on clinical findings, CSF spectrophotometry, computer tomography, and angiography.