Transcranial Doppler ultrasound is a relatively new diagnostic modality which allows the noninvasive assessment of intracranial circulation. A total of 10 migraine patients were studied and compared to healthy controls without headaches. Migraineurs during the headache-free interval demonstrated excessive cerebrovascular reactivity to CO2, evidenced by an increase in middle cerebral artery blood flow velocity of 47% +/- 15% compared to 28% +/- 14% in controls (p = 0.026). Differences between the two study groups revealed no significant decrease in middle cerebral artery blood flow velocity with hypocapnia. However, the differences between middle cerebral artery blood flow velocity during hyperventilation and CO2 inhalation were significantly different (p = 0.004) comparing migraineurs and controls. Instability of the baseline blood flow velocities was also noted in migraineurs during the interictal period. Characteristics which may allow differentiation of migraineurs from other headache populations could possibly be obtained from transcranial Doppler ultrasound flow studies.

Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear.

Disparities in cancer survivorship exist among specific populations of breast cancer survivors, specifically rural African American breast cancer survivors (AA-BCS). While effective survivorship interventions are available to address and improve quality of life, interventions must be culturally tailored for relevance to survivors. Here, we report the results of our formative research using focus groups and in-depth interview to better understand unique rural AA-BCS survivorship experiences and needs in the Alabama Black Belt. Surveys were used to gather sociodemographic and cancer treatment data. Fifteen rural AA-BCS shared their experiences and concerns about keeping their cancer a secret, lack of knowledge about survivorship, lingering symptoms, religion and spirituality, cancer surveillance, and general lack of survivorship education and support. Rural AA-BCS were unwilling to share their cancer diagnosis, preferring to keep it a secret to protect family and friends. Quality-of-life issues like lymphedema body image and sexuality were not well understood. They viewed spirituality and religion as essential in coping and accepting cancer. Participants also discussed the importance of and barriers to maintaining health through regular check-ups. They needed social support from family and friends and health care providers. Overall, rural AA-BCS expressed their need for knowledge about survivorship self-management by providing a vivid picture of the realities of cancer survival based on shared concerns for survivorship support and education within the context of culture.

We identified 60 patients (42 men and 18 women with an average age of 62.6 years) with angiographically documented carotid stenoses of ^95%; a string sign was demonstrated in 28. Twenty of the 60 patients (33%) were asymptomatic on presentation, 26 (43%) had hemispheric transient ischemic attacks, 21 (35%) had amaurosis fugax, and nine (15%) had previous ipsilateral infarctions. Demographics, mode of presentation, and prevalence of atherosclerotic risk factors were not significantly different between patients with and without a string sign. Doppler frequencies recorded in patients with a string sign were <6 or >16 KHz. Real-time ultrasonography imaged a patent lumen in all but three cases with a string sign. Surgery was performed in 26 patients with a string sign and in 21 patients without a string sign. The rate of major pertoperative complications was not influenced by the presence of a string sign, contralateral extracranial stenosis, or ipsilateral siphon stenosis. Average lumen size of the endarterectomy specimens was 0.94 mm in those with and 1.7 mm in those without a string sign. We conclude that combined noninvasive testing has a sensitivity of 83% for demonstrating a residual lumen in patients with ^95% carotid stenosis and that the angiographic string sign does not affect the mode of presentation or surgical outcome of these patients. (Stroke 1990^1:476-479) A high-grade internal carotid artery (ICA) lesion associated with the angiographic appearance L of a tapering, poststenotic segment of markedly reduced caliber (Figure 1) has been referred to as the slim sign, 1 the string sign (SS), 2 or atherosclerotic pseudo-occlusion.3 Collapse of the poststenotic lumen and layering of contrast in the dependent portion of the ICA are postulated to result from low blood flow. 4 The use of delayed films, subtraction techniques, and the hanging head position during angiography may enhance the demonstration of a patent lumen.3 -5 SS also occurs in nonatherosclerotic conditions. 2 -6 -7 We retrospectively reviewed the records of 28 patients with an atherosclerotic SS and 32 patients with ^95% ICA stenosis but no SS with respect to clinical presentation, atherosclerotic risk factors, noninvasive testing, angiographic findings, surgery, and long-term follow-up. Subjects and MethodsThe records of all cerebral arteriograms performed at the Bowman Gray School of Medicine during the From the Department of Neurology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.Presented in part at the annual meeting of the American Academy of Neurology, April 13-19, 1989, Chicago, Illinois. Address for reprints: David S. Lefkowitz, MD, Department of Neurology, Bowman Gray School of Medicine, 300 South Hawthorne Road, Winston-Salem, NC 27103.Received July 6, 1989; accepted October 9, 1989. past 10 years, beginning in January 1978, were retrospectively reviewed. Demographic data, the presence of risk factors for atherosclerosis, medical history, and past treatment were derived from hospital reco...