Background and Purpose-Estimation of stroke incidence among black populations outside the USA and the UK has been hampered by the lack of community-based studies. We aimed to document the incidence of first-ever stroke in Barbados, a Caribbean island with a population of 268 000 people. Methods-A national community-based prospective register of first-ever strokes, using multiple overlapping sources of notification, was established. Results-During the first year, 352 patients (95.2% black) were registered, 142 males and 210 females (59.7%), with a mean age of 72.5 years (range 24 to 104; SD 14.8). Cerebral infarction (IS) occurred in 81.8%, intracerebral hemorrhage (ICH) in 11.9%, subarachnoid hemorrhage (SAH) in 2.0%, whereas 4.3% of strokes were unclassified (UC). The crude annual incidence rate for the black population was 1.40 (95% CI: 1.25,1.55) per 1000 (1.35 standardized to the European population) for all strokes, 1.20 (1.07,1.34) for IS, 0.18 (0.12,0.23) for ICH, and 0.03 (0.01,0.05) for SAH. Lacunar infarction (LACI) accounted for 50.7% of IS among the black population, whereas 15.6% and 26.8% were caused by total anterior circulation infarction (TACI) and partial anterior circulation infarction (PACI), respectively. At 7 and 28 days, respectively, case fatality rates for blacks were 13.1% and 27.8% for all strokes, 46.3% and 58.5% for ICH, 7.6% and 21.7% for IS, 32.6% and 65.1% for TACI, and 2.1% and 9.0% for LACI. Conclusions-Stroke incidence among the black population of Barbados is lower than among African-origin populations in the USA and UK. Lacunar infarction is the predominant stroke subtype.

We report seven patients, including three previously undiagnosed diabetics, who presented with focal seizures and non-ketotic hyperglycaemia. We suggest that once clinicians are made aware of the association between focal seizures and hyperglycaemia, as happened early in 1989 at this hospital, further cases are readily identified and managed more appropriately.Patients and methods Six of the patients were seen by at least one of the authors and five (cases 1, 2, 3, 4, 5) were diagnosed in 1989. We also carried out a search of discharge diagnoses from this hospital for

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