Objective To determine trends in ischemic stroke incidence among Mexican Americans and non-Hispanic whites. Methods We performed population-based stroke surveillance from January 1, 2000 to December 31, 2010 in Corpus Christi, Texas. Ischemic stroke patients 45 years and older were ascertained from potential sources, and charts were abstracted. Neurologists validated cases based on source documentation blinded to ethnicity and age. Crude and age-, sex-, and ethnicity-adjusted annual incidence was calculated for first ever completed ischemic stroke. Poisson regression models were used to calculate adjusted ischemic stroke rates, rate ratios, and trends. Results There were 2,604 ischemic strokes in Mexican Americans and 2,042 in non-Hispanic whites. The rate ratios (Mexican American:non-Hispanic white) were 1.94 (95% confidence interval [CI] = 1.67–2.25), 1.50 (95% CI = 1.35– 1.67), and 1.00 (95% CI = 0.90–1.11) among those aged 45 to 59, 60 to 74, and 75 years and older, respectively, and 1.34 (95% CI = 1.23–1.46) when adjusted for age. Ischemic stroke incidence declined during the study period by 35.9% (95% CI = 25.9–44.5). The decline was limited to those aged ≥60 years, and happened in both ethnic groups similarly (p > 0.10), implying that the disparities seen in the 45- to 74-year age group persist unabated. Interpretation Ischemic stroke incidence rates have declined dramatically in the past decade in both ethnic groups for those aged ≥60 years. However, the disparity between Mexican American and non-Hispanic white stroke rates persists in those <75 years of age. Although the decline in stroke is encouraging, additional prevention efforts targeting young Mexican Americans are warranted.

Objective: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.Methods: Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD 2 score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low (,5%), intermediate (5% to ,10%), and high ($10%) predicted probability risk categories. 05-4.57). No stroke cases were in the model's low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%). Results Conclusion:In acute dizziness presentations, the combination of ABCD 2 score, general neurologic examination, and a specialized OM examination has the capacity to risk-stratify acute stroke on MRI. Neurology ® 2015;85:1869-1878 GLOSSARY ABCD 2 5 age, blood pressure, clinical features, duration, diabetes; CI 5 confidence interval; HINTS 5 head impulse, nystagmus pattern, test of skew; HIT 5 head impulse test; ICH 5 intracerebral hemorrhage; OM 5 ocular motor; OR 5 odds ratio.Patients with dizziness from stroke are challenging to identify because they often lack typical stroke warning signs or symptoms. [1][2][3][4][5][6] Prior studies have been performed to assess bedside decision support tools that could help to discriminate stroke from other causes of acute dizziness.3,4,7 The ABCD 2 score (age, blood pressure, clinical features, duration, and diabetes) may also be useful in discriminating vascular from nonvascular events. [8][9][10] When assessed in a retrospective study of emergency department dizziness presentations, the visits with a low-risk ABCD 2 score (ABCD 2 , 4) had a stroke frequency of 1% (5/512 patients) compared with 8.1% (32/395) in the high-risk group (ABCD 2 $ 4). 3 Another tool that has been developed to identify cases of dizziness-stroke is the HINTS assessment (head impulse, nystagmus pattern, test of skew), which is based on a specialty bedside ocular motor (OM) examination.4 HINTS has shown promising results, superior to the ABCD 2 score (sensitivity/ specificity: ABCD 2 , 61%/62%; HINTS, 96.5%/84.4%) in a prospective study of acute dizziness. 4 In this study, we expand on this prior work by evaluating the ability of the combination of bedside predictors of stroke-including both the ABCD 2 score and the specialized OM examination-to stratify stroke risk using an MR...

Objective: To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. Methods:We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease.Results: A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was 231% (95% CI 247%, 211%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time.Conclusions: ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death. Intracerebral hemorrhage (ICH) accounts for about 10% of all strokes but a disproportionate amount of stroke mortality.1 Incidence of ischemic stroke is declining, 2 and due to shared risk factors, ICH incidence may be expected to be declining as well. Limited data exist on recent trends in ICH burden. Trends in ICH incidence and case fatality were the subject of a 2010 systematic review, 3 though most of the included 36 studies were from before 2000, and few were specifically designed to investigate time trends. An understanding of time trends in the epidemiology of ICH incidence, case fatality, and long-term mortality is necessary to gauge the effectiveness of stroke prevention and treatment efforts.Due to improved control of risk factors such as hypertension over the past decade, 4 there is a need for more recent data on trends in ICH. The objective of this analysis was to investigate trends in ICH incidence, 30-day case fatality, and long-term mortality from 2000 to 2010 within the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project.

Identification of educational processes that encourage a career in academic practice may improve resident mentorship and resident interest in academic plastic surgery.