Stephen J.LurieMD, PhD, Senior Editor
To the Editor: The WHI authors1 reported that HRT increased the risk of stroke in healthy postmenopausal women. The authors use questionable and insufficient criteria to diagnose strokes. Stroke in this study was determined based on "the rapid onset of a neurological deficit lasting more than 24 hours, supported by imaging studies when available." Neurological deficits lasting more than 24 hours, however, are not necessarily caused by strokes. Brain tumors, metabolic disorders, infection, intoxication, and traumatic injury can all mimic stroke. It is often difficult to distinguish these etiologies and requires a skilled neurologist to take a thorough history and perform a neurological examination.
Savitz SI, Caplan L. Risks of Postmenopausal Hormone Replacement. JAMA. 2002;288(22):2822. doi:10.1001/jama.288.22.2822-JLT1211-1-11