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Results for “Transient ischemic attack”

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PubMed1989

Differences in mortality and cardiovascular morbidity during a 3-year follow-up of transient ischemic attacks and minor strokes.

We prospectively followed 78 patients with transient ischemic attacks (TIAs) from the carotid artery territory and 45 patients with minor ischemic strokes for 3 years. The mean +/- SD age of the patients in the TIA group was 66.9 +/- 7.9 years compared with 68.8 +/- 6.7 in the minor stroke group. Mortality among the TIA patients was significantly higher than that among minor stroke patients (18 of 78 compared with two of 45, p less than 0.01); mortality in the minor stroke group was not higher than that in the background population, whereas mortality in the TIA group was almost twice as high. The most common cause of death in the TIA group was myocardial infarction, and morbidity due to myocardial infarction and new TIA was higher in the TIA group than in the minor stroke group (35 events compared with seven), whereas no difference was found regarding stroke (five strokes compared with eight). Preexisting vascular disease implied an increased risk of mortality and morbidity in the TIA group. We conclude that carotid-territory TIA indicates a worse prognosis than minor stroke as mortality is higher in TIA patients at the same preexisting vascular disease prevalence and stroke frequency.

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PubMed2006

Limb-shaking Transient Ischemic Attacks: case report and review of literature.

BACKGROUND: Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually point towards a seizure like activity and misdiagnosed as focal seizures. On careful history the rhythmic seizure like activity reveals no Jacksonian march mainly precipitated by maneuvers which lead to carotid compression. We here present a case of an elderly gentleman who was initially worked up as suffering from epileptic discharge and then later on found to have carotid occlusion. CASE PRESENTATION: Elderly gentleman presented with symptoms of rhythmic jerky movements of the left arm and both the lower limbs. Clinical suspicion of focal epilepsy was made and EEG, MRI-Brain with MRA were done. EEG and MRI-Brain revealed normal findings but the MRA revealed complete occlusion of right internal carotid artery. On a follow-up visit jerky movements of the left arm were precipitated by hyperextension and a tremor of 3-4 Hz was revealed. Based on this the diagnosis of low flow TIA was made the patient was treated conservatively with adjustment of his anti-hypertensive and anti-platelet medications. CONCLUSION: Diagnosis of limb-shaking TIA is important and should be differentiated from other disorders presenting as tremors. Timely diagnosis is important as these patients are shown to benefit from reperfusion procedures either surgical or radiological reducing their risk of stroke.

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PubMed1977

Cooperative study of hospital frequency and character of transient ischemic attacks. I. Background, organization, and clinical survey.

To better understand transient ischemic attacks (TIA), all patients (1,328) with TIA-like symptoms were identified at six participating institutions representing known variations in geography, referral patterns, and socioeconomic status. A total of 954 patients were observed for a mean of 14.3 months. Problems in diagnosis are defined, demographic information is summarized, and features of the histroy, examination, tests, and treatments are noted.

Age Factors↗

PubMedDate not supplied

Hypotension as cause of TIAs (transient ischemic attacks) in patients with severe carotid stenosis and hypertension.

TIAs (Transient Ischemic Attacks) in hypertensive patients with cerebrovascular disease may be caused by a quick decrease of blood pressure. Neurological deficits are possible in patients with critical or subcritical stenoses of vertebral or carotid arteries. In these conditions different flows cause different decreases with the same level of stenosis. So when pressure and flow decrease, the relative importance of stenosis increase and patients may have TIAs. In 10 hypertensive patients with critical arterial stenosis this consequence of clinical events was observed and registered.

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PubMed1999

[Dural arteriovenous fistula at the cranio-cervical junction presenting transient ischemic attack: a case report].

A 58-year-old male was admitted to our hospital because of repeated transient ischemic attack of right hemiparesis and speech disturbance. A CT scan did not demonstrate any remarkable findings. No significant cerebral arterial stenosis or occlusion was found on angiography. However, dural arteriovenous fistula fed by the radiculo-meningeal artery was found at the cranio-cervical junction on left vertebral angiography. The shunt flow from the arteriovenous fistula drained into the superior petrosal sinus and sigmoid sinus in a retrograde fashion. On the angiographic findings when his transient ischemic attack (TIA) had disappeared, the venous drainage had returned to its normal fashion. Venous hypertension around the brain stem was supposed to have caused the transient ischemic attack in this case. We performed coagulation of the draining vein and fistula surgically. After surgery, the patient's TIA completely disappeared. We report the first case of dural arteriovenous fistula at the cranio-cervical junction presenting transient ischemic attack.

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PubMedDate not supplied

Focal parenchymal lesions in transient ischemic attacks: correlation of computed tomography and magnetic resonance imaging.

Twenty-two patients with the clinical diagnosis of transient ischemic attacks were prospectively evaluated by computed tomography (CT) and proton magnetic resonance imaging (MRI). Nineteen patients also underwent cerebral angiography. The MRI studies were performed with a prototype super-conductive magnet using a 0.6 Tesla or a 1.5 Tesla magnetic field. Two pulse sequence techniques were used resulting in T1 and T2 weighted images. All studies were interpreted descriptively by a single neuroradiologist in a blinded fashion, with special attention to focal parenchymal abnormalities. Patients with previously documented clinical strokes or reversible ischemic neurologic deficits lasting more than 24 hours were excluded. The CT scans revealed focal areas of abnormalities in 7 of 22 patients (32%), while the MRI scans showed focal changes in 17 patients (77%). All the CT lesions were clearly visualized on MRI. The MRI changes were better seen on T2 weighted images as areas of increased signal intensity. There was a marked preponderance of deep hemispheric lesions on both CT and MRI studies. Focal parenchymal abnormalities were not limited to the symptomatic vascular territory. We conclude that MRI reveals focal parenchymal changes in the majority of patients with transient ischemic attacks and is more sensitive than late generation CT scans. However, specificity appears to be poor, and may limit clinical usefulness. While the significance of the MRI "lesions" remains speculative, they may represent markers of chronic cerebrovascular disease in these patients.

Adult↗

PubMed1990

The antiphospholipid syndrome: prevalence among patients with stroke and transient ischemic attacks.

PURPOSE: The prevalence of the antiphospholipid syndrome was determined prospectively in patients presenting with stroke and transient ischemic attacks. An attempt was made to define a subset of stroke patients at risk for this syndrome on the basis of their clinical features. PATIENTS AND METHODS: Fifty-one consecutive patients with stroke and transient ischemic attacks were assessed. Tests used for the laboratory diagnosis of the antiphospholipid syndrome included four phospholipid-dependent coagulation tests for detection of the lupus anticoagulant, and two enzyme-linked immunosorbent assays for antibodies to phospholipid. RESULTS: Three of 51 patients (6%, 95% confidence intervals 0% to 12.0%) had a lupus anticoagulant and the clinical features of the antiphospholipid syndrome. Seven patients had clinical features suggestive of the syndrome but negative laboratory tests. Those patients who were clinically unlikely to have this syndrome also had negative laboratory tests. CONCLUSION: In a series of 51 unselected patients presenting with stroke and transient ischemic attacks, three had the antiphospholipid syndrome. The clinical features of this syndrome are helpful in identifying this group of patients. The role of the lupus anticoagulant in the pathogenesis of stroke remains to be defined.

Adolescent↗

PubMed1995

The risk of stroke in patients with first-ever retinal vs hemispheric transient ischemic attacks and high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial.

BACKGROUND: The prognosis of amaurosis fugax has been considered to be favorable compared with that of hemispheric transient ischemic attacks. However, this has remained uncertain for patients with significant carotid stenosis as the assessment of progression of the disease has been confounded when patients undergo carotid endarterectomy. In the North American Symptomatic Carotid Endarterectomy Trial, patients with high-grade (70% to 99%) carotid stenosis were randomized to receive either medical or surgical treatment, thus making an unconfounded analysis possible. METHOD: We identified 129 medically treated patients with high-grade carotid stenosis who had their first-ever transient ischemic attack as the entry event into the trial. Fifty-nine patients with retinal transient ischemic attacks (RTIAs) were compared with 70 patients with hemispheric transient ischemic attacks (HTIAs). RESULTS: Patients with HTIAs were older, with a higher prevalence of most risk factors for stroke. Average time of delay from the onset of transient ischemic attacks to medical treatment was longer for patients with RTIAs than for patients with HTIAs (48.5 vs 15.2 days). Kaplan-Meier estimates of the risk of ipsilateral stroke at 2 years were 16.6% +/- 5.6% for patients with RTIAs and 43.5% +/- 6.7% for patients with HTIAs (P = .002 for the difference in risk between RTIAs and HTIAs). From corresponding Cox's proportional hazards regression analyses, the risk of ipsilateral stroke ranged from 11.2% to 28.9% for patients with RTIAs and from 37.4% to 96.3% for patients with HTIAs across stenoses, spanning 75% to 95%. Overall, the relative risk of ipsilateral stroke (HTIAs compared with RTIAs) was 3.23 (95% confidence interval, 1.47 to 7.12), regardless of the degree of high-grade stenosis. CONCLUSION: To our knowledge, this study is the first report on the expected outcome for medically treated patients with high-grade (70% to 99%) carotid stenosis in whom the first-ever event was either an RTIA or HTIA. The presence of RTIAs carries a considerable risk of ipsilateral strokes, particularly at higher degrees of stenosis. However, in comparison with HTIAs, patients with RTIAs still have a better prognosis.

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PubMed2002

Etiology, duration, and prognosis of transient ischemic attacks: an analysis from the German Stroke Data Bank.

CONTEXT: A transient ischemic attack (TIA) has been arbitrarily defined as a focal cerebral ischemic deficit lasting less than 24 hours. OBJECTIVE: To determine if TIAs of short duration (<1 hour) and long duration (1 hour to <24 hours) differ from each other and from ischemic stroke (IS). DESIGN, SETTING, AND PATIENTS: Inception cohorts of 1429 patients with acute TIAs and 5206 patients with IS were prospectively documented in 15 German medical centers with neurology departments and acute stroke units. Outcome after 3 months was assessed in 72.8% of the patients with TIAs. MAIN OUTCOME MEASURES: Risk factor distribution, etiology, and prognosis of TIAs and IS. RESULTS: Patients with TIAs, especially those with symptoms lasting less than 1 hour, were significantly more likely to have a history of TIAs and less likely to have diabetes mellitus, arterial hypertension, or atrial fibrillation at admission compared with those with IS. Cardioembolic etiologies were less frequent and unknown etiologies more frequent among patients with TIAs than those with IS. Functional outcome and mortality did not differ significantly in patients with TIAs of different durations. CONCLUSION: This study demonstrates differences in comorbidity and etiology among patients with TIAs of different durations and IS.

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PubMed1975

Carotid endarterectomy for nonhemispheric transient ischemic attacks.

Fifty carotid endarterectomies were performed in 46 patients with nonhemispheric transient ischemic attacks. There was no mortality. Three patients had temporary strokes postoperatively. Ninety-five percent of the patients were improved and remained so at follow-up examination. Clinical improvement was not related to the presence or absence of vertebral or subclavian stenosis. In retrospect, the two patients who were unimproved had been improperly selected.

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PubMed1990

Fatal or severely disabling cerebral infarction during hospitalization for stroke or transient ischemic attack.

Six (1%) of 578 patients admitted for cerebral infarction or transient ischemic attack (TIA) suffered a fatal or severely disabling in-hospital cerebral infarction following a period of stabilization or improvement lasting more than 1 day. These infarctions were characterized by the sudden onset of stupor or coma and subsequent development of transtentorial herniation due to carotid or middle cerebral artery territory infarction, or widespread brain-stem infarction due to basilar occlusion. Only one patient survived. Four patients had large-vessel disease documented by Doppler, angiography, or at autopsy. Each of these six infarcts occurred during the morning hours, 4-9 days after the initial event, 3-8 days after initiation of intravenous heparin, and within 4-8 h after intravenous heparin had been discontinued. No coagulation abnormalities were documented. We believe that these cases indicate that among patients admitted for cerebral infarction or TIA, fatal or severely disabling in-hospital cerebral infarction after a period of stabilization or improvement may occur in patients having an initially mild to moderate clinical deficit, that those suffering large artery disease may be at greater risk, and that there may be a relationship between heparin withdrawal and cerebral infarction in some patients.

Cerebral Infarction↗

PubMed2001

An analysis on the diagnostic values of transcranial Doppler and angiography in transient ischemic attack.

The accuracy and diagnostic values of transcranial Doppler (TCD) in transient ischemic attack (TIA) caused by the stenosis or occlusion of intracranial or extracranial blood vessels were investigated. Of the 50 TIA patients receiving routine TCD examinations, 39 cases (77%) were diagnosed as having unilateral or bilateral stenosis or occlusion of MCA, ACA, siphon segment of internal carotid artery, which was furthermore confirmed by digital subtraction angiography (DSA) or MRA, 11 (22%) cases were normal. An analysis on the TCD findings of the flow patterns and hemodynamic changes of the stenotic or occluded blood vessels was made in comparison with that obtained by angiography. It was showed that angiography demonstrated 17 unilateral MCA stenosis, 47 bilateral multi-stenosis, 1 occlusion of the siphon segment of the internal carotid artery, while TCD revealed 17 unilateral stenosis, 64 bilateral stenosis, 1 occlusion respectively, with an accordance rate of 78.7%. It was concluded that the hemodynamic changes secondary to the stenosis of the basalcranial arteries, especially the moderate to severe stenosis or occlusion, might be an important risk factor for TIA. TCD examination achieved significant clinic values in the diagnosing of TIA.

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PubMed1991

Transient ischemic attacks: an update.

This is a review of extant concepts of transient ischemic attacks (TIAs), their definitions, prognostic significance, pathogenesis, physiology, and management. The natural history of TIAs depends upon the risk factors of the population group studied, so that therapeutic trials should be controlled and randomized and not dependent upon published natural history data. A strong association between TIAs and coronary artery disease has now been established. It may be difficult to establish the cause or pathogenesis of TIAs in any given patient in view of the relatively poor correlation between the patient's symptoms and location of arterial plaques. Recent studies have suggested mechanisms aside from impaired perfusion or embolization from carotid plaques or vertebral basilar disease. There are no proven indications for carotid endarterectomy, a procedure which has been excessively used in the United States, but presently ongoing prospective, randomized, controlled multi-center studies will likely resolve this important issue. Neither is there scientific validation for the use of long-term anticoagulants, but data support the efficacy of ASA in reducing the incidence of stroke and myocardial infarction in patients with TIAs.

Anticoagulants↗

PubMed1981

Long-term prognosis after transient ischemic attacks.

A retrospective follow-up study of 243 patients with transient ischemic attacks (TIA) is reported. The long-term mortality of the patients was higher than that of the corresponding general population. It is demonstrated that the excess mortality over the whole period of observation, irrespective of the age and sex of the patients, can be characterized by a single figure expressing the slope of the curve obtained by semilogarithmic plotting of the ratios of observed to expected survival against time. The use of this numerical expression--in the present series -0.04--will thus facilitate comparisons of the survival of TIA patients drawn from different populations. Unfavourable prognostic factors were: carotid TIA, associated extracerebral disease, and a history of hypertension. Fatal strokes, being four times as frequent as expected according to published incidence figures, accounted for 20% of the deaths, heart disease 38%. Stroke deaths tended to occur earlier than cardiac deaths. The results support the concept that most TIAs, like strokes, are incidents in the progressive course of a generalized vascular disease. The finding of a constant excess mortality over the years following a TIA makes it difficult to recommend a discontinuation of prophylactic therapy at any particular time.

Age Factors↗

PubMed2002

Pure or predominantly sensory transient ischemic attacks associated with posterior cerebral artery stenosis.

Pure or predominantly sensory transient ischemic attacks (ps-TIAs) are uncommon, and underlying vascular abnormalities have rarely been described. The author reports 5 patients with TIAs which were of short duration, stereotypical and purely or predominantly sensory in nature. Brain MRI did not reveal any lesions, while angiography demonstrated focal stenoses in the proximal portion of the posterior cerebral artery (PCA). It is concluded that ps-TIAs strongly suggest the presence of PCA disease. Repeated compromise of small vessels supplying the posterior-lateral part of the thalamus seems to be the pathogenic mechanism.

Adult↗

PubMed1989

Changes in survival after transient ischemic attacks: observations comparing the 1970s and 1980s.

We compared survival following transient ischemic attack (TIA) in 2 prospective cohorts of TIA patients admitted to Wake Forest University Medical Center. The 1st consisted of 177 patients admitted between 1961 and 1973, and the 2nd of 185 patients admitted between 1980 and 1983. Patients in the 2nd cohort had significantly greater longevity than patients in the 1st cohort, both univariately and after adjustment for cerebrovascular risk factors. The adjusted 1-year survival estimate increased from 91% in the 1st cohort to 98% in the 2nd, and the adjusted 3-year survival estimate increased from 83% in the 1st to 94% in the 2nd. The underlying causes for this dramatic improvement in survival may include early identification and aggressive management of TIAs or coexisting diseases, improved management of subsequent completed strokes or myocardial infarctions, or unadjusted differences in these cohorts. The data imply that reports of TIA survival from different periods may not be comparable.

Cohort Studies↗

PubMed1997

[Adhesion of erythrocytes of patients with transient ischemic attack to injured endothelial cells].

Adherence of erythrocytes of patients with transient ischemic attack(TIA) to human umbilical vein endothelial cells(HUVEC) treated with H2O2 were quantitatively studied in the flow chamber system. The results showed that injured HUVECs enhanced the adherence of erythrocytes to endothelial cells in patients with TIA. The increased adhesion of erythrocytes to endothelial cells might promote the vascular damage. Consequently endothelium might play an important role in the increased adhesiveness of TIA RBC to endothelial cells.

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PubMedDate not supplied

[Transient ischemic attack as the presenting symptom of a pulmonary arteriovenous fistula].

INTRODUCTION: Transient ischemic attacks (TIA) occur as the clinical manifestation of a pulmonary arteriovenous malformation in up to 20% of cases. CASE REPORT: We report the case of a 41-year-old female with an episode of TIA lasting half an hour, with right-side hemiparesis caused by a paradoxical embolisation due to the presence of a single pulmonary arteriovenous fistula (PAVF). Complementary analytical and imaging tests (CAT scan of the head without contrast, brain RMI and intra and extracranial MR-angiography) were normal. A transthoracic echocardiogram showed the presence of a patent foramen ovale which obstructed the passage of hemoce, although it was observed in the left auricle after presumably arriving through the pulmonary arteries. Since a pulmonary vascular malformation was suspected, a computerised tomographic angiography scan of the thorax was performed and this confirmed the presence of a single PAVF in the right lung. A pulmonary arteriography was then carried out to confirm the presence of the malformation, which was later embolised. Two months later, the patient was asymptomatic and the fistula did not appear in the computerised tomographic angiography scan of the thorax. CONCLUSIONS: PAVFs can give rise to neurological conditions due to paradoxical embolisms that can produce abscesses and infarcts and/or concomitant lesions in the central nervous system. This is a certain indication of treatment of the malformation and the preferred technique is endovascular embolisation with coils, while surgery is reserved for cases in which endovascular treatment is not possible.

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