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We analyzed four personal cases and 51 reported cases of dissecting aneurysms of the arteries of the head and neck. Subintimal dissection more commonly affects the intracranial vessels before age 40. In contrast, medial dissection tends to affect extracranial vessels after age 30. Vertebrobasilar dissection more variably affects either arterial plane. The reasons for these differing patterns of dissection are still not clear. In young subjects, the subintimal layer appears to be more susceptible; in contrast, the media becomes increasingly vulnerable with age, particularly in the presence of acquired medial disease.

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Three patients were initially seen with headache, blurred vision, and papilledema while taking lithium carbonate for their respective bipolar affective disorder. A diagnosis of pseudotumor cerebri was made in each case when a thorough evaluation revealed only elevated intracranial pressure. Two of the patients had complete resolution of their symptoms and papilledema after discontinuing use of the drug. Increased intracranial pressure with papilledema persisted in the third patient when she failed to adjust psychiatrically, necessitating continuance of the lithium carbonate therapy. A history of lithium carbonate ingestion should be sought in patients with the syndrome of pseudotumor cerebri. All patients receiving this drug should have a regular funduscopic examination.

SUMMARY The etiologic and prognostic features which characterize cerebrovascular disease in the later decades of life are not applicable in younger patients. The records of 58 patients who had suffered cerebral infarction between the ages of 15 and 40 were reviewed in order to study these features.Fifty-five percent of the patients were found to have had an identifiable etiology for their cerebral infarction, with nearly half of these suffering from embolic infarction of cardiac origin. In 45% no clear etiology could be established but hypertension was prevalent in those patients between 31 and 40 years of age. Follow up data were obtained on 68% of the hospital survivors; nearly V* of them had completely recovered or had improved.CEREBROVASCULAR DISEASE occurs predominately in the later decades of life. However, the occurrence of stroke in young adults is not an insignificant problem. The annual incidence of stroke in the 35 to 45 age group is estimated at 25 per 100,000.' Aring and Merritt, 2 in an age incidence tabulation of autopsied cases of cerebrovascular lesions, found that 5% of strokes occur in individuals under 40. It has been pointed out that this figure relates to necropsied cases, and that the actual incidence may be greater. 3Two large studies of cerebrovascular disease originating from India 4 and Ceylon 5 estimate that 27.2% and 32% respectively of all strokes occur in adults under 40. These findings may not be applicable to other world populations because of differences in culture, diet, genetics, or other unidentified factors.The etiologic and prognostic features which characterize cerebral infarction among older patients may not be applicable to young adults. Because of the relatively low prevalence of degenerative arterial disease in the young, potentially treatable non-atheromatous conditions may exist in the young adult with stroke.7 Despite careful investigation, among young patients many cases of ischemic cerebrovascular disease emerge in which the etiology is unclear and the role of established risk factors is uncertain. 8 " 12 In order to examine these factors, the records of young adults with cerebral infarction who had been hospitalized at the Medical College of Virginia hospitals were reviewed. MethodsThe Medical College of Virginia Hospital is a large urban teaching center with a population of referral as well as community care patients. The medical records of all inpatients age 15 to 40 with cerebrovascular disease admitted to the Medical College of Virginia Hospitals between August 1, 1970 and July 31, 1975 were reviewed retrospectively.Patients included in the study had suffered cerebral infarction just prior to admission or while in the hospital. Patients with hemorrhagic strokes were not included. If a patient had more than one cerebral infarct during the period of the study, only the first was included. This study was supported in part by the Student Clerkship in stroke sponsored by the American Heart Association.Patient data collected included family history, predisposi...