Background and Purpose— The term “minor stroke” is often used; however a consensus definition is lacking. We explored the relationship of 6 “minor stroke” definitions and outcome and tested their validity in subgroups of patients. Methods— A total of 760 consecutive patients with acute ischemic strokes were classified according to the following definitions: A, score ≤1 on every National Institutes of Health Stroke Scale (NIHSS) item and normal consciousness; B, lacunar-like syndrome; C, motor deficits with or without sensory deficits; D, NIHSS ≤9 excluding those with aphasia, neglect, or decreased consciousness; E, NIHSS ≤9; and F, NIHSS ≤3. Short-term outcome was considered favorable when patients were discharged home, and favorable medium-term outcome was defined as a modified Rankin Scale score of ≤2 at 3 months. The following subgroup analyses were performed by definition: sex, age, anterior versus posterior and right versus left hemispheric stroke, and early (0 to 6 hours) versus late admission (6 to 24 hours) to the hospital. Results— Short-term and medium-term outcomes were most favorable in patients with definition A (74% and 90%, respectively) and F (71% and 90%, respectively). Patients with definition C and anterior circulation strokes were more likely to be discharged home than patients with posterior circulation strokes ( P =0.021). The medium-term outcome of older patients with definition E was less favorable compared with the outcome of younger ones ( P =0.001), whereas patients with definition A, D, and F did not show different outcomes in any subgroup. Conclusions— Patients fulfilling definition A and F had best short-term and medium-term outcomes. They would be best suited to the definition of “minor stroke.”

Allogeneic hematopoietic SCT (HSCT) has been proposed as a treatment for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). HSCT has been performed in nine patients using different protocols with varying success. Based on this preliminary experience, participants of the first consensus conference propose a common approach to allogeneic HSCT in MNGIE. Standardization of the transplant protocol and the clinical and biochemical assessments will allow evaluation of the safety and efficacy of HSCT as well as optimization of therapy for patients with MNGIE.

We analyzed sex differences in 696 patients with spontaneous cervical artery dissection. There were more men (n = 399; p < 0.0001), and men showed a higher frequency of hypertension (31% vs 15%; p < 0.0001). Women were younger (42.5 +/- 9.9 vs 47.5 +/- 9.3 years; p < 0.0001), had more often multiple dissections (18 vs 10%; p = 0.001), migraine (47 vs 20%; p < 0.0001), and tinnitus (16 vs 8%; p = 0.001). Outcome and mortality were similar in both sexes.

Background and Purpose-Transient elevation of arterial blood pressure (BP) is frequent in acute ischemic stroke and may help to increase perfusion of tissue jeopardized by ischemia. If this is true, recanalization may eliminate the need for this BP elevation. Methods-We analyzed BP in 149 patients with acute ischemic stroke on admission to the hospital and 1 and 12 hours after intraarterial thrombolysis. BP values of patients with adequate recanalization were compared with BP values of patients with inadequate recanalization. Recanalization was determined on cerebral arteriography after thrombolysis using thrombolysis in myocardial infarction grades. Results-Systolic, mean, and diastolic arterial BP decreased significantly from admission to 12 hours after thrombolysis in all patients (PϽ0.001 H ypertension is the most prevalent modifiable risk factor for ischemic and hemorrhagic stroke. Approximately two-thirds of the cerebrovascular disease burden are attributable to nonoptimum blood pressure (BP). Blood pressure levels are positively and continuously associated with the risk of stroke in a log-linear fashion for first-ever and recurrent stroke. 1,2 Lowering BP reduces the risk, both in primary and secondary prevention, and larger reductions in BP produce larger reductions in stroke risk. 3 Up to 80% of patients show elevated BP values within the first 24 to 48 hours after stroke onset, which subside over the next few days or weeks. 4 However, unlike the wellestablished knowledge of BP management to prevent stroke, few data are available about handling BP in the acute setting. The pathophysiology of high BP in acute stroke is complex and poorly understood, and there is a lack of adequate evidence to guide therapeutic decisions. Thrombotic or embolic occlusion of a cerebral artery is the cause of acute ischemic stroke and therefore also the first link in the pathogenetic chain of BP elevation. Therefore, the reverse See Editorial Comment, page 268should also be true. If the occluded vessel is recanalized, BP should decline more rapidly than with persistent occlusion. To verify or reject this hypothesis, we correlated BP values and the grade of recanalization in a series of patients who were treated with intraarterial thrombolysis. Materials and MethodsFrom January 2000 to December 2003, 160 patients with acute ischemic stroke were treated with intra-arterial thrombolysis (IAT) at our institution. Many aspects of some of these patients and the technique used for IAT have been published previously. 5-7 All patients were evaluated by a neurologist after arrival at the emergency department and a computed tomography or magnetic resonance imaging scan was obtained to rule out hemorrhage or other nonischemic causes of the ictus, patients underwent arteriography, and, if feasible (and visible artery occlusion on arteriography), thrombolysis. When BP exceeded 185/110 mm Hg antihypertensive agents were given. The first-line agent was labetalol. Second-line drugs were angiotensin-converting enzyme inhibitors or angioten...