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(Stroke. 1999;30:1490-1493.)
© 1999 American Heart Association, Inc.

Letters to the Editor

Types of Recurrent Stroke in Survivors of Intracerebral Hemorrhage

Raymond T. F. Cheung, MBBS, PhD, MRCP

Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong

To the Editor:

I read with great interest the recent article¹ by Arakawa and colleagues. In this important study, Arakawa and colleagues followed up 74 patients with hypertensive brain hemorrhage for a mean of 2.8 years and reported higher diastolic blood pressure (DBP) but not higher systolic blood pressure (SBP) as the risk factor for recurrent brain hemorrhage. I would make the following comments.

First, recurrent stroke affected 9 of the 74 patients; the type of recurrent stroke was intracerebral hemorrhage (ICH) in 8 (89%) and ischemic stroke (IS) in 1 (11%).¹ Although most of the recurrent strokes are of the same type as the first episode in patients surviving from IS, this may not apply to survivors of ICH. In a study by Yamamoto and Bogousslavsky,² the recurrent strokes were of the same type as the initial strokes in 77% of patients with cardioembolic IS, 65% with nonlacunar noncardioembolic IS, 58% with ICH, and 48% with lacunar IS. I wonder whether Arakawa and colleagues have any explanation for the high consistency rate of 89% of recurrent ICH observed in their cohort. From our database of information prospectively gathered between October 1996 and January 1999 (Cheung, unpublished data, 1999), 138 of 607 stroke patients had a previous history of stroke. Of 120 patients with a previous history of IS, the type of recurrent stroke was IS in 108 (90%) and ICH in 12 (10%). Of 16 patients with a previous history of ICH, the recurrent stroke was ICH in 5 . . . [Full Text of this Article]

Shuji Arakawa, MD

Department of Cerebrovascular Disease, Institute of Neuroscience, St. Mary's Hospital, Kurume, Japan

Setsuro Ibayashi, MD, PhD; Tetsuhiko Nagao, MD, PhD Masatoshi Fujishima, MD, PhD

Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan