Cigarette smoking is a significant risk factor for aneurysm rupture, according to a study in the September Journal of Neurosurgery.The authors reviewed the records of 142 subjects (with a total of 181 unruptured aneurysms diagnosed between 1956 and 1978) until 1998 (or until death or aneurysm rupture). From 1996 to 1998, all of the patients who were still alive were interviewed; a structured questionnaire that included data on height, weight, personal and familial medical history, drug use, intake of caffeine and alcohol, and smoking status was used. Aneurysm size and the subject's age (inversely) and smoking status were independent predictors for subsequent aneurysm rupture. Smoking may cause aneurysm formation by weakening the vessel walls of cerebral arteries, noted the authors. They added that smoking may lead to aneurysm rupture by raising blood pressure and by increasing the size of the aneurysm.

Parkinson's disease is twice as likely to occur in men as in women, according to a study in the November 14 Neurology.A population-based, parkinsonism-free cohort of 4,341 elderly men and women in eight Italian municipalities were followed for an average of three years. Three major findings were discovered within the final cohort of 3,084—the incidence of parkinsonism increases with age, men have a higher risk of developing parkinsonism than women have, and Parkinson's disease is the most common type of parkinsonism and shows age and sex patterns similar to those of parkinsonism. Researchers believe that estrogen may play a protective role in women. The increasing incidence of parkinsonism with age lends weight to the theory that Parkinson's disease is a result of the interaction between normal aging and environmental or genetic risk factors.

Phenylpropanolamine in appetite suppressants, and possibly in cough and cold remedies, is an independent risk factor for hemorrhagic stroke in women, according to a report in the December 21 New England Journal of Medicine.This case-control study included data on 702 patients and 1,376 controls (men and women ages 18 to 49). None of the men reported using appetite suppressants, and there was no evidence that phenylpropanolamine-containing cough and cold remedies increased risk of hemorrhagic stroke in men.

Patients' awareness of stroke symptoms and how they decide to get to the hospital were the two key reasons for delays in administering thrombolytic therapy following stroke, according to two studies reported in the November Stroke."The time a patient takes deciding to seek care is the biggest portion of the time between onset of symptoms and treatment," said Emily Schroeder, MSPH, lead author of one of the studies. "Once EMS (emergency medical service) is alerted, things can happen quickly, but people don't call 911 unless they perceive their symptoms to be urgent." According to the studies, the median prehospital delay time was 2.85 hours for patients who used EMS, compared with 4.03 hours for those who did not. "Even the 2.85-hour median elapsed time for patients using EMS is far too slow," Ms. Schroeder said. "It can take an hour or more to complete and interpret necessary tests, like a CT scan, which have to be done before thrombolytic therapy can be given."

Black patients who underwent elective carotid endarterectomy had an increased incidence of in-hospital stroke, longer hospital stays, and higher hospital charges than white patients had, according to a study reported in the November Annals of Surgery.In reviewing the Maryland Health Services Cost Review Commission database from 1990 to 1995, researchers determined that the in-hospital stroke rate was 1.6% among the 9,219 white patients who underwent the procedure; it was between 1.7% and 3.1% among the 623 black patients who underwent the procedure. Bruce Perler, MD, Professor of Surgery at Johns Hopkins Hospital in Baltimore, noted that African Americans are more likely than whites to undergo the surgery in low-volume hospitals with less-experienced surgeons. "This study suggests that it is not necessarily genetic, but socioeconomic factors that are influential in determining surgical outcome," he said.

Dietary supplements containing ephedra alkaloids may pose a health risk to some of the 12 million people who use these products annually, according to a study in the December 21 New England Journal of Medicine.The researchers reviewed 140 reports (submitted to the Food and Drug Administration between June 1, 1997, and March 31, 1999) of adverse events related to dietary supplements containing ephedra alkaloids; 31% were considered to be definitely or probably related to the use of ephedra, and 31% were deemed to be possibly related. Cardiovascular symptoms made up 47% of the adverse events, with hypertension being the single most frequent adverse event. Of the central nervous system adverse events reported (18%), strokes and seizures were the most frequent. Twenty-six percent of all adverse events resulted in permanent impairment, and 10 events resulted in death.

More years since surgeon's licensure, very low patient volume, and a specialty other than neurosurgery are associated with worse patient outcomes following carotid endarterectomies, according to a study by researchers from Cornell University, Ithaca, New York. The study, published in the September 26 Neurology,analyzed the outcomes of 12,725 carotid endarterectomies performed by 532 surgeons between 1994 and 1995 in Pennsylvania. The researchers wrote that "time in surgical practice was more important than surgical volume as a predictor of patient outcome." They added that physicians who have been in practice the longest may be less likely to adopt new procedural improvements, or they may use more resident staff in their surgeries. Interestingly, co-author Arthur Hartz, MD, PhD, found similar results among surgeons who perform heart bypass surgeries.

White stroke patients may have a higher incidence of atherosclerotic plaques than black stroke patients, according to a study presented at the American Heart Association's 73rd Annual Scientific Sessions in New Orleans. This is surprising, according to researcher Navin Nanda, MD, because other research has shown that blacks are more likely than whites to have high blood pressure. Among the 1,692 patients studied, the frequency of plaques in the ascending aorta, the aortic arch, and the descending aorta was significantly higher in whites than in blacks. Typically, complex plaques are more likely to rupture and become mobile, said Dr. Nanda. "We need to check for risk factors such as high blood pressure, smoking, diabetes, obesity, and family history of heart disease to see if there are any relationships between the number of risk factors and the racial differences," he said.

A genetic mutation that disrupts the energy-producing machinery of cells can lead to Parkinson's disease, according to a study in the November Annals of Neurology. Researchers isolated a mitochondrial DNA (mtDNA) mutation that is responsible for a constellation of symptoms, including deafness, neuropathy, and, in some cases, parkinsonism. "Mutations in mtDNA are probably rare causes of Parkinson's disease, but our findings are noteworthy in that they confirm that mitochondrial dysfunction is important in the pathogenesis of Parkinson's [disease], as already suspected," said study co-author Salvatore DiMauro, MD. The mutation was found in a family with roots around Naples, Italy.

Ubiquilin may modulate presenilin protein, the accumulation of which is associated with neurofibrillary tangles and Lewy bodies in the neuropathology of Alzheimer's disease, according to a study in the November 13 Journal of Cell Biology."Ubiquilin is the first molecule, to our knowledge, that has been found to increase presenilin levels in cells. Now, we want to see how ubiquilin regulates presenilin proteins carrying Alzheimer's disease mutations. This is an important step in understanding presenilins and may lead to eventual treatments or cures for the neuropathological diseases," said co-author Mervyn Monteiro, PhD.

There is an extensive and widespread accumulation of nitrated a-synuclein in the signature inclusions of brains of people who have Parkinson's disease, dementia with Lewy bodies, the Lewy body variant of Alzheimer's disease, or multiple system atrophy, according to a study in the November 3 Science.The findings suggest that impairment of cellular antioxidative mechanisms or overproduction of reactive species may be a primary event leading to the onset and progression of neurodegenerative synucleinopathies. Researcher Virginia Lee, MD, stated that these findings "may pave the way for developing therapies to stop or slow the oxidative damage, and thus slow or reverse the progression of these diseases."