In our population-based study, we found a high stroke incidence notably in the older age subgroups, suggesting that rather than declining, stroke is only being postponed until later in life.

Background and Purpose-Stroke type in the young may influence the outcome and may have a dramatic impact on the quality of life in survivors. This study aimed to evaluate the incidence and prognosis of first-ever stroke in the young and to make comparisons with older patients within a well-defined population. Methods-All first-ever strokes occurring in the L'Aquila district, central Italy, were traced by active monitoring of inpatient and outpatient health services. Incidence rates were standardized to the 1996 European population according to the direct method. Long-term survival was estimated by the Kaplan-Meier method; outcome in survivors was evaluated by the modified Rankin scale. Results-Of 4353 patients who had a first-ever stroke, 89 patients Ͻ45 years of age (55 men and 34 women) (2%) were identified in a 5-year period. Mean ageϮSD was 36.1Ϯ8.1 years. Twenty patients (22.5%) had a subarachnoid hemorrhage, 18 (20.2%) an intracerebral hemorrhage, and 51 (57.3%) a cerebral infarction. The corresponding proportions in patients Ͼ45 years of age were 2.4%, 13.3%, and 83.1%. Neuroimaging studies of the brain detected 14 intracranial aneurysms and 6 arteriovenous malformations in 20 of 38 patients (52.6%) with either subarachnoid (nϭ17) or intracerebral (nϭ3) hemorrhage. The crude annual incidence rate was 10.18/100 000 (95% CI, 8.14 to 12.57) and 10.23/100 000 when standardized to the 1996 European population. The 30-day case-fatality rate was 11.2% (95% CI, 6.2 to 19.4). Patients with subarachnoid hemorrhage had the highest proportion of good recovery (60%), patients with intracerebral hemorrhage had the highest mortality (44%), and patients with cerebral infarction had the highest proportion of severe disability (47%). Conclusions-Stroke patients Ͻ45 years of age showed a disproportionate cumulative high prevalence (42.7%) of subarachnoid and intracerebral hemorrhage with respect to older patients (15.7%), mainly (52.6%) due to aneurysms and arteriovenous malformations. Therefore, screening procedures and preventive strategies in the young should also be addressed to subjects at risk of subarachnoid and intracerebral hemorrhage. (Stroke. 2001;32:52-56.)

The burden of ischemic stroke is high in subjects 80 years old or older, contributing about one-third of health care utilization and 59.8% of deaths within 30 days.

The prevalence of internal carotid artery (ICA) morphological variations (MV), their characteristics, and their possible association with carotid stenosis, vascular risk factors, and previous transient ischemic attack or ischemic stroke was investigated in a consecutive series of patients.Within a seven-month period, 1217 patients (557 men and 660 women; mean age [± SD] 62.7±18.1 years) consecutively referred to the Laboratory of Neurosonology, University of L'Aquila, Italy, underwent a neck vessel examination using a high-resolution B-mode ultrasound device with a 7.5 MHz linear phased array probe.ICA MV were present in 319 (26.2%) patients; they were unilateral in 201 patients (63.0%) and bilateral in 118 patients (37.0%). Patients with ICA MV were older than those without ICA MV (66.3±19.9 years versus 61.4±18.0 years, P<0.0001) and were mostly women (62.4%, P=0.0008). Tortuosity was present in 195 (44.6%) arteries, kinking in 236 arteries (54.0%) and coiling in six arteries (1.4%). Carotid stenosis was found in 270 patients (22.2%). Among patients with ICA stenosis, MV were found in 134 patients (49.6%). Mean neck length was similar in patients with and without ICA MV (12.1±2.4 cm versus 12.6±2.9 cm, P=0.4). In the multivariate logistic regression analysis, the presence of ICA MV was associated with female sex and older age.Tortuosity and kinking were frequently encountered during neurovascular examination. Their presence was usually related to aging and female sex, and did not imply any additive risk for stroke, although further studies are needed to clarify this point.

Transcranial Doppler is routinely used to assess the cerebrovascular reactivity, despite scarce information on its reproducibility. We evaluated the reproducibility of cerebrovascular reactivity measurements by this method utilizing different vasodilatory and vasoconstrictor stimuli. The cerebrovascular reactivity was measured in 45 healthy volunteers during hypercapnia induced by inhalation of a mixture of 5% CO₂ and 95% O₂, breath holding and rebreathing, and during hypocapnia induced by voluntary hyperventilation. Three sets of measurements were performed at times 0, 1, and 24 h to assess the within-observer short- and long-term reproducibility. The reproducibility was analyzed using the intraclass correlation coefficient. For the CO₂ inhalation method, a good short-term (r_I = 0.55; 95% CI = 0.39–0.68) and a good long-term (r_I = 0.43; 95% CI = 0.25–0.59) reproducibility was found. For the breath-holding method a good short-term agreement was found (r_I = 0.41; 95% CI = 0.22–0.57), while the long-term reproducibility was poor (r_I = 0.17; 95% CI = –0.03–0.36). Rebreathing showed a fair (r_I = 0.31; 95% CI = 0.11–0.48) short-term and a poor (r_I = 0.17; 95% CI = –0.03–0.36) long-term reproducibility. For voluntary hyperventilation, the short-term reproducibility was good (r_I = 0.53; 95% CI = 0.36–0.66), and the long- term reproducibility was fair (r_I = 0.31; 95% CI = 0.11–0.48). In our study, CO₂ inhalation and voluntary hyperventilation had the highest reproducibility and should be preferred when assessing cerebral vasoreactivity, especially in follow-up studies.