No uniformly accepted hypothesis explains the genesis and rupture of intracranial aneurysms. We followed 5,184 men and women prospectively for 26 years; 36 cases of aneurysmal subarachnoid hemorrhage (SAH) accounted for 62% of all intracranial hemorrhages. Blood pressure before SAH was higher in these patients than in controls. Definite hypertension (greater than or equal to 160 mm Hg and/or greater than or equal to 95 mm Hg) at entry to the study or at closest exam before SAH was more frequent than in controls. Cigarette smoking, particularly heavy smoking, was also more frequent among cases.

A door-to-door survey was carried out to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases. High school graduates, social workers, and medical students administered a screening questionnaire that in a pilot survey had a sensitivity of 100% for identifying persons with epilepsy. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. Sixty-six persons (43 males, 23 females) suffered from epilepsy (4.7 cases/1,000). Of those, 50 (34 males, 16 females) had active epilepsy (3.6 cases/1,000). The age-specific prevalence ratios remained fairly constant for each age group except for a small peak in the group aged 20-39 years for all epilepsy cases combined. Age-adjusted prevalence ratios were higher for males. The most common seizure type was partial (36 cases). The most frequently associated conditions were cerebral palsy and mental retardation. The majority of individuals were receiving medication as of prevalence day (47 cases).

SUMMARY The role of Atrial Fibrillation (AF) as a precursor of stroke was examined in the Fram ingham cohort based on 30 years of follow-up during which time 501 strokes occurred. There were 59 persons who sustained stroke in association with AF excluding those with rheumatic heart disease. AF increased the risk of stroke five-fold and the excess risk was found to be independent of the frequently associated cardiac failure and coronary heart disease. The contribution of AF to stroke risk was also at least as powerful as that of the other cardiovascular precursors.Stroke associated with AF was not only independent and substantial but also imminent. There was a distinct clustering of stroke events at the time of onet of the AF. Thirty day case-fatality rates were no different in those with strokes accompanied by AF than not at 17% versus 19% respectively. Recurrences in those with AF were only slightly more frequent, 25% versus 20%, a difference that was not statistically significant. Stroke recurrence in the first 6 months following initial stroke was more than twice as common (47% versus 20%) in the AF group. Stroke, Vol 14, No 5, 1983CHRONIC AF unassociated with rheumatic heart dis ease (RHD) has been found to be related to an in creased incidence of stroke. Prospective eidemiologic study at Framingham, MA discloses stroke incidence following chronic nonrheumatic AF is increased more than five-fold even after age, sex, and the frequently associated hypertension is taken into account. 1Some have suggested that paroxysmal, intermittent and recent-onset AF is particularly hazardous with an excess of stroke occurring in this group. 2From the standpoint of prevention, clarification of this point is essential. We have studied the development of stroke in relation to duration of AF in a general population sample followed prospectively since 1950, comprising 30 years of follow-up. The purpose of the present re port is to examine the time course of this threat of stroke, the likelihood and temporal pattern of stroke recurrences and case-fatality rates. MethodsWe evaluated the development of stroke in 5184 men and women, aged 30 to 62, and free of stroke at entry followed for 30 years. Sampling procedure, cri teria, and methods of examination have been described elsewhere.3 Subjects were examined every two years. Follow-up was satisfactory with 81 % taking all possi ble examinations and less than five percent of the origi nal cohort lost to mortality follow-up.On each of the 16 biennial examinations, the subject was routinely questioned by a physician concerning habits, medications, and illnesses during the preceding two years. Physical examination and laboratory stud ies were made, and details surrounding all interim ill nesses were sought. For stroke, including transient ischemic attacks (TIAs), surveillance was maintained by daily monitoring of all admissions to the only gen eral hospital in town. If stroke was suspected, the patient was seen in the hospital by the study neurolo gist. Neurologic symptoms or signs not...

Summary:During the last two decades, there has been a renewed interest in studying epidemiology of epilepsy in developing countries. While there are data on prevalence of epilepsy from many developing countries, there is very little information on the mortality of epilepsy in these same populations. This is because incidence studies of epilepsy are difficult to perform, death certificates are unreliable and often unavailable, and the cause of death is difficult to determine. We report on several studies of mortality in epilepsy in developing countries: Ecuador; the Parsi community of Bombay; a semiurban community in Vasai, India; Mali; Martinique; and Africa. Overall, these studies in general illustrate excess mortality among people with epilepsy when compared with the general population.

To determine which conditions may be associated with reduced survival in patients with Alzheimer's disease, we studied all death certificates in the United States for 1978 on which senile and presenile dementia (ICDA 290, N = 7,195) was mentioned. Each case was compared with two control deaths. Differences in the frequency of listing on the death certificates for the following conditions reached statistical significance: infections, trauma, nutritional deficiency, chronic ulcer of skin, foreign body in pharynx, cataract, glaucoma, blindness, deafness, Parkinson's disease, and epilepsy. There seem to be many preventable and treatable disorders in patients with senile and presenile dementia.