Response to Letter by Ashrafian
The author is to be congratulated for his scholarly awareness of struggles in the Middle East in ancient days. He has pointed out that in successive generations of a military family, 2 men at arms experienced “a stroke.” There the facts remain and forever will be unchanged. Important developments have accumulated since that time. Knowledge about “strokes” is today regarded as fragmentary without adequate data supporting the cause and the type of event. Plainly, these 21st-century mandates cannot be expected of reports that are 2500 years old. It is pleasant to amuse oneself by reflecting on what may have been the familial events here. Could the heat of battle and the heavy armor have triggered cerebral thrombosis in a family afflicted with sickle-cell disorder? Could they both have been manifestations of the earliest (un)recorded CADASIL? Could familial hypercholesterolemia or homocysteinemia have been the trigger for premature atheroma? Could they have a familial tendency to a cardiac lesion (eg, mitral valve prolapse or septal defect) with emboli? Could the exertion of battle have led to symptoms from a previously existing subdural hematoma? Could they both have had familial aneurysms? Speculation has not been exhausted, but this report allows us to reflect on our progress. Different causes of stroke demand of us different thoughts about investigation. Therapy is not for the genus “stroke” but is tailored to the cause. The Karolinska article related only to stroke attributable to atheroma in a large artery.