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Anticoagulation-related hemorrhage in acute cerebral embolism.

To the Editor: In the recent paper of Corston, Kendall and Marshall on middle cerebral artery stenosis published in the March-April 1984 STROKE, the authors proposed that the prognosis of this condition was not as benign as that previously reported by Hinton et al.' In fact, a critical review of the series of Corston et al. does reveal a surprisingly benign clinical course. Of the eleven patients in their series treated with aspirin, aspirin and dipyrimadole, or nothing at all, six suffered no new deficits during follow-up. There were three deaths, two due to cancer, and one from unknown causes, and there were only two strokes. 1 would have anticipated many more neurologic complications in this group. Because the paper of Hinton et al. suggests that Warfarin might be an effective treatment for middle cerebral artery stenosis, I was interested in the outcome of the patients in Corston, Kendall and Marshall's group who were treated with this medication. Only two patients in their series appear to have been treated with Warfarin throughout the entire duration of their follow-up. If my interpretation of their paper is correct, only a single patient, badly impaired with an initial stroke, went on to have two additional strokes on Warfarin therapy. Could the authors tell us if their patient's Warfarin therapy was managed appropriately and if the strokes were suffered in the hemisphere ipsilateral to the stenosis. It was also interesting to note that of the four patients dying because of an infarct on the side of the middle cerebral stenosis, only one of these patients appears to have been on Warfarin at the time of the fatal stroke. R. Michael Scott, M.D., F.A.C.S. Department of Neurosurgery Tufts-New England Medical Center Boston, Massachusetts