FEATURES, SYMPTOMS, AND NEUROPHYSIOLOGICAL FINDINGS IN STROKE ASSOCIATED WITH HYPERHOMOCYSTEINEMIA

Background: Hyperhomocysteinemia has been shown to be a mild independe nt risk factor for premature atherosclerosis, and there is evidence of an increased rate of peripheral vascular occlusive disease, myocardia l infarction, and stroke. Objective: To evaluate clinical, biochemical , and neurophysiological findings in patients with ischemic stroke wit h and without hyperhomocysteinemia. Subjects: One hundred twenty-five consecutive patients with a history of stroke and 60 healthy control s ubjects. Methods: Patients were divided into those with and those with out hyperhomocysteinemia, which was defined as blood levels beyond the mean total plasma homocysteine level plus 2 SDs of the healthy contro l group. History, symptoms, cause, patterns of infarction, biochemical data, continuous and transcranial Doppler sonography, and event-relat ed potentials were recorded in all patients. Results: Twenty-seven pat ients had hyperhomocysteinemia. Compared with the 98 patients without hyperhomocysteinemia, they had an increased rate of hypertension (odds ratio, 3.5; 95% confidence interval, 1.0-12.6), an increased level of uric acid (P<.007), an increased hematocrit (P<.02), a higher rate of microangiopathy (odds ratio, 2.8; 95% confidence interval, 1.1-7.2), and a trend to a higher rate of multiple infarction. Furthermore, the P3 latency of the event-related potential was significantly increased in hyperhomocysteinemia (P<.004). Conclusions: Hyperhomocysteinemia is probably an independent risk factor for stroke, with a prevalence of about 20% in all patients with a history of stroke; however, additiona l factors leg, hypertension, hyperuricemia) may have an enhancing effe ct. There are significant differences in stroke patterns between patie nts with and without hyperhomocysteinemia, with a higher rate of lesio ns typical of cerebral microangiopathy and a trend to multiple infarct ions in the former. Impairment of cognitive processing as measured by visual event-related potential is more pronounced in hyperhomocysteine mia.