Precipitating Factors, Prognosis, and Demography of Cerebrovascular Disease in an Indiana Community: A Review of All Patients Hospitalized from 1963 to 1965 With Neurological Examination of Survivors

As an initial step in studying the characteristics of cerebrovascular disease in a geographically limited segment of population, the hospital records of 285 patients coded as "CNS vascular" in the Elkhart General Hospital (Indiana) were reviewed for the years 1963, 1964 and 1965 by a team of neurology residents, under the supervision of the author. Information from examination of almost half the group by a team of neurologists and data from relatives, family physicians, hospital records and death certificates concerning the remainder led to the conclusion that the original diagnosis of "CNS vascular" could not be substantiated in 25 patients (9%), was cerebral infarction in 125 (53%), cerebral hemorrhage in 40 patients (14%), subarachnoid hemorrhage in 21 patients (7%), generalized atherosclerosis in 24 patients (8%), and transient focal cerebral ischemic attacks in 25 patients (9%). Disorders such as diabetes, hypertension, heart disease, myocardial infarction, auricular fibrillation and genitourinary disease were significantly more frequent in patients with cerebral infarction than in a group of similar age and sex patients collected from the same hospital in an attempt to form a ",contrast group." However, hypertension was the only disorder significantly more often associated with cerebral hemorrhage. Cigarette consumption was increased at a highly significant level in the males who had infarction and the prognosis was, in general, unfavorably affected by older age, further cerebrovascular events, and abnormal electrocardiograms. Eighty-three percent of the patients with cerebral hemorrhage died during initial hospitalization.