In men with coronary heart disease, low HDL cholesterol, and low LDL cholesterol, gemfibrozil reduces stroke incidence.

Silent cerebral infarction is frequently seen in asymptomatic patients with atrial fibrillation. Age, history of hypertension, active angina, and elevated mean systolic blood pressure were associated with silent infarction at entry. The sample size was too small to determine whether warfarin had an effect on the incidence of silent infarction during the trial. Active angina at baseline was the only significant independent predictor for the later development of symptomatic stroke.

We retrospectively reviewed the clinical characteristics and outcomes of 61 patients with 62 episodes of prosthetic valve endocarditis, paying particular attention to neurologic complications (stroke). Atypical features of the group included a benign outcome of early postoperative infection (18% mortality) and a high stroke morbidity and mortality rate with Staphylococcus epidermidis infections. Eleven patients (18%) suffered an embolic stroke, most <3 days after diagnosis and before the initiation of antimicrobial therapy; the rate of embolic stroke recurrence was low (9%). The risk of embolic stroke was lower with bioprosthetic than with mechanical valves. No protective effect of anticoagulation therapy with warfarin was observed. Six patients (8%) suffered brain hemorrhage due to septic arteritis, brain infarction, or undetermined causes; no specific risk of hemorrhagic stroke was evident with anticoagulation therapy. Antibiotic treatment appears to be more important than anticoagulation to prevent neurologic complications in patients with prosthetic valve endocarditis. {Stroke 1990;21:993-999) T he management of patients with prosthetic valve endocarditis has been controversial, with the neurologic sequelae of embolic stroke and cerebral hemorrhage being particularly salient issues. Many studies have reported embolic stroke rates of 25-60% in patients not receiving anticoagulation therapy as part of their medical regimen.1^3 Other anecdotal reports 4 and reviews 5 have emphasized the risk of cerebral hemorrhage. Despite the increasing use of heterograft bioprostheses over the past 2 decades, specific treatment and neurologic outcomes of these patients have not been systematically reported. 6 -11 We analyzed 62 episodes of prosthetic valve endocarditis in 61 patients, paying special attention to predictors of embolic stroke and brain hemorrhage. Our data emphasize the heterogeneous nature of the patient population and the practical limitations of management of these difficult cases. Subjects and MethodsWe reviewed the medical records of all patients with prosthetic valve endocarditis at eight universityaffiliated hospitals in four cities: Columbia, Mo. for

Symmetrical polyneuropathy developed in two patients after they had been in contact with acrylamide and methyl n-butyl ketone, respectively. In sural nerve biopsy material from both patients, electron microscopy showed frequent focal axonal swellings containing masses of neurofilaments. Some axons undergoing axonal degeneration also were seen. These morphologic features are identical to those produced in experimental animals after exposure to these chemicals and are similar to those found in n-hexane neuropathy and in the three reported cases of giant axonal neuropathy. Sural nerve biopsy is an important diagnostic test in identifying cases of peripheral neuropathy caused by these chemicals.