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To the Editor We thank Dr. Marta Moreno and colleagues for their comments on the importance of fluid and nutritional support in stroke. In our study, which involved small numbers, it would not have been valid to undertake small subgroup analysis. Furthermore, a primary aim was to study patients managed in the usual way in our hospital as a prelude to interventional protocols. More specifically, no patient was enterally fed, the United Kingdom differing from many other countries in this respect. Thus all patients had been fasting at the time of blood sampling. We did record fluid balance, though not fluid type, and this has been related to changes in plasma osmolality and arginine vasopressin. On the basis of this work, we have misgivings about standardized fluid regimens after stroke. We consider that there is considerable scope for the study of the management of patients in the acute stages of stroke, with fluid and nutritional support being of major importance.

Occipitoatlantal instability: a hemodynamic cause of vertebrobasilar ischemia after neck motion.