A 10-year review of the Mayo Clinic experience with childhood cerebrovascular disease unrelated to birth, intracranial infection, or trauma identified 69 patients (38 with ischemic stroke, and 31 with subarachnoid or intracerebral hemorrhage). Although children with cerebral infarction had better survival, they experienced more residual disability than children with cerebral hemorrhage. The medical records-linkage system for Rochester, Minnesota residents made it possible for the first time to study cerebrovascular disease in a well-defined childhood population. Records from all medical facilities serving this population (average of 15,834 resident children) showed four strokes over 10 years (average annual incidence rate of 2.52 cases per 100,000 per year).

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A cohort of 1,804 residents of Rochester, Minnesota, who were at least 50 years old, free of stroke, and who underwent examination at the Mayo Clinic in 1960, was followed for 13 years. During this period, there were 110 first ischemic strokes and 616 deaths without stroke. The time of onset, if available, or the time of diagnosis of potential risk factors was determined for all patients during the study and was used to construct a proportional hazards model of time to occurrence of stroke with time-dependent risk factors. The model included 8 risk factors (2 fixed and 6 time-dependent). For these, the individual relative risks are: 1.6 for age (per 10 years), 2.0 for males, 4.0 for definite hypertension, 3.9 for transient ischemic attacks, 2.2 for hypertensive heart disease, 2.2 for coronary heart disease, 1.7 for congestive heart failure, and 1.7 for diabetes mellitus. Atrial fibrillation was not a significant risk factor using time-dependent multivariate analysis.

Average annual cerebrovascular disease (CVD) mortality rates (age-adjusted to the 1950 US population) were calculated using data from 1967 through 1973 for 33 countries. Rates range from 35.8/100,000/year (Philippines) to 196.7/100,000/year (Japan). There is also considerable variation among the nations of Europe and North America. Comparing these results with similar information for the 1950s shows a marked decrease for CVD mortality in approximately two-thirds of the countries for which data are available. Nations with low rates in the 1950s generally show an increase in CVD mortality rates. This most probably represents improvements in case ascertainment and diagnosis. Despite the problems inherent in mortality tabulations for neurologic diseases, the data reveal interesting patterns.

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