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Two patients, one with a persistent hypoglossal artery and the other with a persistent trigeminal artery, presented with transient ischemic attacks in the distribution of the posterior fossa. Both had stenosis and ulcerative plaques at the carotid bifurcation. Their symptoms were successfully relieved after carotid endarterectomy.
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In a 5 1/2-year study in 585 patients, aspirin, 1200 mg/day, reduced 50% the risk of stroke or death in men who had experienced at least one episode of neurological disability in carotid or vertebral-basilar territory. Adding sulfinpyrazone to aspirin did not improve the results, and sulfinpyrazone alone was no better than placebo. Women did not experience the same benefit; aspirin did not reduce their risk of stroke or death.
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The incidence of TIA, stroke, and neuropathy was studied in a community-based maturity-onset diabetic population. The frequencies of TIA and stroke were increased in maturity-onset diabetic patients as compared to the population of Rochester, Minnesota. The median age of occurrence of TIA and stroke in diabetics was 74 years, not significantly different from that in non-diabetics. Diabetic patients with hypertension at the time of diagnosis of diabetes mellitus had an increased frequency of TIA and stroke. Control of hypertension and/or diabetes mellitus was associated with a decreased frequency of TIA or stroke. Obesity, clinical coronary heart disease, and an abnormal electrocardiogram at the time of diagnosis of diabetes mellitus were not associated with a significantly increased frequency of TIA or stroke. The most common type of peripheral neuropathy in diabetes mellitus was distal polyneuropathy. Mononeuropathy and autonomic neuropathy were much less frequent. The frequency of distal polyneuropathy increased with the duration of diabetes mellitus. The frequency of neuropathy was increased in patients with poor control, reemphasizing the importance of diabetic control in the prevention of diabetic complications.