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PubMed1989

[The correlation of transient ischemic attack and cerebrovascular accident].

Correlation exists between the occurrence of a transient ischemic attack (TIA) and a cerebrovascular accident (CVA). The strength of this correlation however is a point for debate. We studied the sequential relation between the occurrence of TIA and CVA in patients over 50 years in general practice. Based on Continuous Morbidity Registration (CMR) in four general practices we analysed the morbidity in patients who presented symptoms of TIA and (or) CVA during the period 1971-1983. In this period a TIA was diagnosed in 134 persons and a CVA in 214 persons. The maximal observation period of the TIA patients after presentation of the symptoms was 12 1/2 years. In 8% of the CVA cases a TIA had been diagnosed in the period preceding the CVA. Of the TIA patients 13% developed a CVA in the subsequent observation period, half of them within two years after the TIA diagnosis. Comparison of the incidence rate of CVA in the general population with that in the population with a TIA reveals that a CVA development is about six times more frequent in the latter. This higher risk has only a relative meaning because the absolute number of cases is small.

Cerebrovascular Disorders↗

PubMed1977

Cooperative study of hospital frequency and character of transient ischemic attacks. V. Symptom analysis.

All patients (1,328) suspected of having transient ischemic attacks (TIA) who came to six institutions during a 21-month period were identified. Symptoms and symptom complexes were related to the clinical diagnoses by cross-tabulation, factor analysis, and discriminant analysis. The diagnoses obtained by the discriminant analysis program were comparable to those of reviewing clinical neurologists. Symptoms of importance in the vertebral-basilar system (VBS) were bilateral visual blurring, diplopia, ataxia, and dizziness; In either carotid system (CAS), ipsilateral monocular visual disturbance anc contralateral weakness or sensory complaints; in the left CAS, language disturbances; and in those whose ultimate diagnosis was not TIA, loss of consciousness, confusion, and bilateral leg weakness. Patients with VBS TIAs have symptoms common to conditions that are not TIA and have a greater variety of symptoms and more combinations of symptoms than CAS TIA.

Aphasia↗

PubMed1999

Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks.

BACKGROUND: Patent foramen ovale (PFO) is found in up to 50% of patients less than 55 years of age who have had a stroke. Therapeutic options include no therapy, antiplatelet therapy, warfarin and surgical closure of the PFO. OBJECTIVES: To determine the relative and attributable risks of PFO for recurrent cerebral ischemic events in young patients with stroke or transient ischemic attacks. The predictors of recurrent cerebral ischemic events and the effects of different therapies on recurrence rates were sought. DESIGN: Follow-up of a retrospective cohort of patients with cryptogenic stroke or transient ischemic attacks identified from an echocardiography database. SETTING: University-based regional neurology referral centre. PATIENTS: Consecutive group of 90 patients less than 60 years of age who underwent transesophageal echocardiography following a cryptogenic transient ischemic attack (TIA) or stroke (cerebrovascular accident [CVA]) between 1991 and 1997. INTERVENTIONS: Structured telephone interviews and chart reviews. RESULTS: Fifty-two patients had a PFO, and 38 patients did not have a PFO. During a mean follow-up of 46 months, 19 recurrent cerebral ischemic events (12 TIA and seven CVA) occurred in 14 patients with PFO, and eight recurrent events (three TIA and five CVA) occurred in six patients without PFO. The recurrence rates were 12% and 5%/patient/year in the PFO and control groups, respectively, for a crude recurrence rate ratio of 2.39 (95% CI 1.01 to 6.32, P < 0.03). The attributable risk of PFO in recurrent neurological events was 7%/patient/year. In a Cox regression model, predictors of recurrent neurological events were presence of PFO (hazard ratio 5.27, 95% CI 1.58 to 17.6, P < 0.007), history of migraine (hazard ratio 4.54, 95% CI 1.11 to 18.52, P < 0.035), hypertension requiring therapy (hazard ratio 3.5, 95% CI 1.33 to 9.01, P < 0.01), and antiplatelet or no therapy instead of warfarin therapy (hazard ratio 2.88, 95% CI 1.11 to 8.7, P < 0.04). Fourteen patients underwent surgical closure of PFO; there were no neurological recurrences during a mean follow-up of 43 months (crude incidence rate difference 12%/patient/year, 95% CI 6.6 to 17.9, P < 0.02). CONCLUSIONS: Patients with PFO had a significantly higher rate of recurrent cerebral ischemic events than those without PFO. Surgical PFO closure prevented any recurrences during a mean follow-up of 43 months. Warfarin was better than antiplatelet therapy or no therapy in preventing recurrences.

Adolescent↗

PubMed1992

Long-term prognosis of infratentorial transient ischemic attacks and minor strokes.

BACKGROUND AND PURPOSE: This study was performed to gather information about long-term prognosis after infratentorial transient ischemic attacks and minor strokes and about the factors influencing it. METHODS: We included 226 patients with transient ischemia and 169 patients with a minor stroke of the brain stem/cerebellum consecutively admitted to a neurological department. Medical records and the findings of computed tomography, Doppler ultrasonography, and angiography were evaluated retrospectively. Follow-up information was gathered from the patients and their physicians by questionnaires. Complete follow-up information was available for 381 patients. RESULTS: During a mean follow-up of 3.9 years, 15.7% of the 381 patients suffered a stroke and 6.8% a myocardial infarction; 15% died. Kaplan-Meier estimates revealed a cumulative stroke rate of 5.1% within the first year and a risk of stroke, myocardial infarction, or death of any cause of 9.8%. In a proportional hazards model, the time-dependent risk of stroke was significantly increased by increasing age (p = 0.018), minor stroke (p = 0.0005), hypertension (p = 0.022), previous stroke (p = 0.0006), and carotid artery occlusive disease (p = 0.0065). The probability of stroke, myocardial infarction, or death was influenced by age (p = 0.0001), minor stroke (p = 0.006), diabetes (p = 0.015), previous stroke (p = 0.002), infarct on a computed tomogram (p = 0.041), and carotid artery disease (p = 0.032). CONCLUSIONS: Long-term prognosis after brain stem/cerebellar transient ischemic attacks and minor strokes is significantly influenced by age, diabetes, hypertension, previous stroke, and concomitant carotid artery disease. Patients with transient ischemic attacks have a better prognosis than those with minor stroke.

Cerebellum↗

PubMed1985

Platelet behavior in patients with TIA: responsiveness to small doses of aspirin.

To study platelet role in cerebrovascular disease, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) plasma levels, indices of in vivo platelet activation, were assayed in a group of patients affected by cerebral ischemic attack (transient ischemic attack; TIA). Determinations were carried out within 1 month from the ischemic event and following short-term (1 month) and long-term (1 year) daily administration of low doses (50 mg) of aspirin (ASA). After the cerebral ischemic event, beta-TG and PF4 plasma levels were elevated. beta-TG and PF4 plasma levels did not decrease after 1 month of treatment with ASA and significantly increased in all the patients after 1 year. Such a trend can perhaps be related to the natural course of the disease and associated with the possible occurrence of collagen-induced platelet activation in cerebrovascular patients. Data suggest that although platelet activation occurs in TIA-affected patients, the high levels of beta-TG and PF4 may not be adequate parameters for evaluation of TIA relapses and ASA efficacy.

Adult↗

PubMed1992

Extracranial carotid arterial disease: a prognostic factor for atherothrombotic brain infarction and cerebral transient ischemic attack.

A prospective study investigated the prevalence of extracranial carotid arterial disease by carotid duplex ultrasonography, and evaluated its correlation with the incidence of atherothrombotic brain infarction or cerebral transient ischemic attack in 949 patients, mean age 82 +/- 8 years. The mean follow-up period was 45 months. Of 949 patients, 37 (4%) had 80%-100% extracranial carotid disease (mean follow-up, 24 +/- 15 months), 113 (12%) had 40%-80% extracranial carotid disease (40 +/- 19 months follow-up), and 799 (84%) had 0%-40% extracranial carotid disease (47 +/- 14 months follow-up). The average annual incidence of atherothrombotic brain infarction was 37% in patients with 80%-100% extracranial carotid disease, 9% in patients with 40%-80% extracranial carotid disease, and 4% in patients with 0%-40% extracranial carotid disease. The average annual incidence of transient ischemic attack was 3% in patients with 80%-100% extracranial carotid disease, 2% in patients with 40%-80% extracranial carotid disease, and 1% in patients with 0%-40% extracranial carotid disease. The Cox proportional hazard model showed that among the variables evaluated, the severity of extracranial carotid disease correlated with the highest relative risk of developing atherothrombotic brain infarction (2.5x higher relative risk) or transient ischemic attack (2.8x higher relative risk). Patients with an earlier atherothrombotic brain infarction had a 2.1x higher probability of developing atherothrombotic brain infarction and a 1.9x higher chance of developing transient ischemic attack than those without an earlier atherothrombotic brain infarction. Age was a prognostic variable for new atherothrombotic brain infarction, and male sex was a prognostic variable for new transient ischemic attack.

Aged↗

PubMed1999

Preventing stroke in patients with transient ischemic attacks.

Stroke is the third most common overall cause of death and the leading cause of adult disability in the United States. New therapeutic interventions instituted in the period immediately after a stroke have revolutionized the approach to ischemic cerebrovascular disease. Recognition of a transient ischemic attack provides an opportunity to prevent a subsequent stroke. Specific stroke prevention treatment depends on the cause of the transient ischemic attack, its cerebrovascular localization and the presence of associated coexisting medical problems. Modification of stroke risk factors is the principal therapeutic approach. Antiplatelet agents and anticoagulants have been shown to be effective in reducing the occurrence of stroke in certain populations. Several well-designed studies have recently demonstrated the effectiveness of carotid endarterectomy in preventing strokes related to extracranial carotid artery disease.

Adult↗

PubMed2000

New transient ischemic attack and stroke: outpatient management by primary care physicians.

BACKGROUND: Patients with transient ischemic attack (TIA) or stroke frequently first contact their primary care physician rather than seeking care at a hospital emergency department. The purpose of the present study was to identify a group of patients seen by primary care physicians in an office setting for a first-ever TIA or stroke and characterize their evaluation and management. METHODS: Practice audit based on retrospective, structured medical record abstraction from 27 primary care medical practices in 2 geographically separate communities in the eastern United States. RESULTS: Ninety-five patients with a first-ever TIA and 81 with stroke were identified. Seventy-nine percent of those with TIA vs 88% with stroke were evaluated on the day their symptoms occurred (P =.12). Only 6% were admitted to a hospital for evaluation and treatment on the day of the index visit (2% TIA; 10% stroke; P =.03); only an additional 3% were admitted during the subsequent 30 days. Specialists were consulted for 45% of patients. A brain imaging study (computed tomography or magnetic resonance imaging) was ordered on the day of the index visit in 30% (23% TIA, 37% stroke; P =.04), regardless of whether the patient was referred to a specialist. Carotid ultrasound studies were obtained in 28% (40% TIA, 14% stroke; P<.001), electrocardiograms in 19% (18% TIA, 21% stroke; P =.60), and echocardiograms in 16% (19% TIA, 14% stroke; P =.34). Fewer than half of patients with a prior history of atrial fibrillation (n = 24) underwent anticoagulation when evaluated at the index visit. Thirty-two percent of patients (31% TIA, 33% stroke; P =.70) were not hospitalized and had no evaluations performed during the first month after presenting to a primary care physician with a first TIA or stroke. Of these patients, 59% had a change in antiplatelet therapy on the day of the index visit. CONCLUSIONS: Further primary care physician education regarding the importance of promptly and fully evaluating patients with TIA or stroke may be warranted, and barriers to implementation of established secondary stroke prevention strategies need to be carefully explored. Arch Intern Med. 2000;160:2941-2946

Aged↗

PubMed1975

Transient ischemic attacks due to atherosclerosis. A prospective study of 160 patients.

Patients with transient ischemic attacks (TIAs) due to atherosclerosis were studied by aortocranial arteriography. Onset of TIAs was before age 55 in 24% and between 55 and 64 in 47%. Men exceeded women by two to one. Of 160 patients, 77 were treated medically and 82 surgically. Five died in the immediate postoperative period. In the survivors, mortality has been the same in the medically and surgically managed groups. For patients with multiple lesions, surgical reconstruction of the carotid arteries was associated with very high surgical risk. In the medically treated group, anticoagulant therapy reduced the frequency of TIAs, but did not appear to protect patients from stroke. Mortality was 23% at four years, 57% of deaths being attributable to myocardial infarction and 38% to stroke.

Adult↗

PubMed2000

Necrosis of the tongue after transient ischemic attack.

We report an unusual case of necrosis of the tongue after transient ischemic attack in a 67-year-old man. Angiography revealed occlusion of the right external carotid artery at the bifurcation of the common carotid artery. Debridement of the wound and removal of the necrotic tissue resulted in good healing.

Aged↗

PubMed1994

Prognostic indicators for mortality in transient ischemic attack and minor stroke.

In a prospective study, 129 consecutive patients with transient ischemic attacks (TIAs) and 80 consecutive patients with minor ischemic stroke, involving the carotid artery territory in both cases, were followed-up for six years from their inclusion during the period from January 1984 to October 1985. All patients were 40-80 years old at inclusion, the median age being 74 years in the TIA group and 76 years in the minor stroke group. Overall mortality in the TIA group was significantly higher than in the minor stroke group, [44%, (57/129) vs 20% (16/80), p < 0.0006 after correction for age], and that in the general population of Malmö. Pre-existing vascular disease was slightly more prevalent in the TIA than in the minor stroke group [27% (35/129 vs 21% (17/80), NS]. Of the 19 patients with intermittent claudication, who all died [12 (63%) of them due to myocardial infarction (MI)], 18 belonged to the TIA group and only one to the minor stroke group. The respective frequencies of the putative risk factors in the TIA and minor stroke groups were 28% (36/129) vs 9% (7/80) for hypertension (p = 0.016), 9% (12/129) vs 6% (5/80) for diabetes mellitus (NS), and 8% (10/129) vs 9% (7/80) for cardiac arrhythmia (NS). Mortality due to MI was higher in the TIA than in the minor stroke group[24% (31/129) vs 6% (5/80), p = 0.001]. Of the minor stroke patients, none without vascular disease died of MI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Predictive implications of recurrent transient ischemic attacks in large-artery atherosclerosis.

BACKGROUND: It is uncertain whether recurrent transient ischemic attacks (R-TIAs), when comparing with single TIAs (S-TIAs), have any distinct mechanisms. METHODS: All consecutive patients with TIAs, who had been admitted for a 2-year period, were divided into two groups: those who had R-TIAs and those who had S-TIAs. Registry data, medical records, and imaging findings were reviewed and compared between the two groups. RESULTS: There were 85 patients who had TIAs: 42 patients had R-TIAs, and 43 patients had S-TIAs. On univariate analysis, R-TIA patients had less cardiac embolic TIA sources, less weakness, less speech disturbances, shorter symptom duration, a longer time interval from onset to treatment, less abnormalities on diffusion-weighted magnetic resonance imaging, and more significant relevant arterial stenoses. After logistic regression analysis, independent factors associated with R-TIAs were symptom duration < 10 min (odds ratio OR 3.62; 95% confidence interval CI 1.37-9.57), > or = 50% stenosis of the clinically relevant artery (OR 7.08; 95% CI 1.29-38.71), and absence of cardiac embolic sources (OR 0.04; 95% CI 0.002-0.71). CONCLUSIONS: R-TIAs may have pathophysiological mechanisms distinct from those of S-TIAs and so may provide a clue for the etiologic diagnosis, in that patients with R-TIAs are more likely to have large-artery atherosclerosis.

Angiography, Digital Subtraction↗

PubMed1994

Occurrence of transient ischemic attacks in Alcoi: descriptive epidemiology.

A door-to-door survey of transient ischemic attack (TIA) and stroke was conducted in 3 towns of the Alcoi health area. The prevalence ratios found for TIA and stroke were 13/1,000 people (95% CI 8.8-17.9) and 21.5/1,000 (95% CI 15.8-27.2), respectively. The crude incidence rates for both TIA and stroke were 2.8/1,000 (95% CI 0.7-4.9). Methodological differences in the ascertainment of the cases may explain the variations in the rates between the present work and other studies in the literature.

Adult↗

PubMed1979

CT evaluation in patients with transient ischemic attack. Correlation between clinical and angiographic findings.

35 patients clinically diagnosed with transient ischemic attack (TIA) and 15 patients clinically diagnosed with reversible ischemic neurological deficits (RIND) were examined by computerized tomography (CT). 34% of TIA patients showed positive CT scans consisting of small hypodenase areas: 60% of RIND patients had larger lesions. In 20% of the overall group the only pathological finding consisted of unilateral focal atophy or ventricular asymmetry. Correlation between angiographically demonstrated atherosclerotic lesions and positive CT was high. On the contrary, no correlation was found between either the risk factors or the natural history of ischemic attack and positive CT findings.

Adult↗

PubMed2003

Cognitive impairment is related to cerebral lactate in patients with carotid artery occlusion and ipsilateral transient ischemic attacks.

BACKGROUND AND PURPOSE: Patients with carotid artery occlusion (CAO) and ipsilateral transient ischemic attack (TIA) can have lasting cognitive impairment, despite the recovery of focal neurological deficits. We sought to assess whether cognitive impairment in these patients is associated with hemodynamic compromise and/or impaired cerebral metabolism. METHODS: In 39 consecutive patients with a TIA associated with an angiographically proven occlusion of the carotid artery, we examined (1) cognitive functioning, (2) cerebrovascular reserve capacity of the middle cerebral artery ipsilateral to the CAO as measured by transcranial Doppler ultrasound, and (3) metabolic ratios as measured by 1H-MR spectroscopy in the centrum semiovale ipsilateral to the symptomatic CAO. Findings were compared with those in healthy control subjects. RESULTS: As a group, patients were cognitively impaired. Mean CO2 reactivity and the mean ratio of N-acetyl aspartate to creatine were decreased. In approximately one third of patients, lactate was present in noninfarcted regions. The presence of lactate proved to be a stronger correlate of cognitive impairment than MRI-detected lesions (beta=0.41 versus beta=0.15). Cognitive impairment did not correlate with CO2 reactivity or the ratio of N-acetyl aspartate to creatine. CONCLUSIONS: This exploratory study in patients with CAO and ipsilateral TIA showed that 1H-MR spectroscopy-detected lactate in noninfarcted regions is a better indicator of cognitive impairment than MRI-detected lesions. Cognitive impairment did not correlate with CO2 reactivity.

Adult↗

PubMed2004

Predictive values of lacunar transient ischemic attacks.

BACKGROUND AND PURPOSE: We postulated that a lacunar syndrome occurring with transient ischemic attacks (TIAs) or progressive nonsudden onset predicts a brain infarction (BI), presumably caused by a small artery disease (ie, lacunar BI) better than a lacunar syndrome with sudden onset. METHODS: We included 510 patients with BI. BI was classified into etiologic groups including lacunar BI group. We identified the patients with lacunar or nonlacunar syndrome, and those with TIAs preceding the BI or with symptoms of nonsudden onset. RESULTS: Nonlacunar syndrome had a negative predictive value for a lacunar BI of 95%. A lacunar syndrome had a positive predictive value (PPV) of 57% for lacunar infarction (n=109), and the PPV increased to 79% in the case of recent TIAs preceding the lacunar syndrome. Hypertension was present in 95% of cases with lacunar TIAs (odds ratio: 10.69; 95% confidence interval: 1.34 to 84.82; P=0.02). CONCLUSIONS: Lacunar TIAs are almost always associated with history of arterial hypertension and have a high PPV for lacunar BI. This subgroup of patients may reflect different underlying mechanisms than the group of patient with lacunar syndrome of sudden onset.

Adolescent↗

PubMed1998

Transient ischemic attacks caused by trumpet playing.

We report a young musician who experienced transient ischemic attacks during trumpet playing. Cardiovascular examination revealed a patent foramen ovale; Doppler ultrasound of the middle cerebral arteries detected microembolic signals with increased rates during trumpet playing and Valsalva maneuver. After operative occlusion of the foramen ovale, the symptoms disappeared and no microembolic signals could be detected.

Adolescent↗

PubMed2004

Transient ischemic attack reported with paroxetine use.

OBJECTIVE: To report the occurrence of a transient ischemic attack (TIA) temporally related to the initiation of paroxetine. CASE SUMMARY: A 57-year-old white man with a history of intermittent atrial fibrillation and hypercholesterolemia developed slurred speech and a facial droop 3 days after starting paroxetine. He was diagnosed with a TIA, hospitalized, and given anticoagulation treatment. The presenting symptoms resolved, but recurred when paroxetine was restarted 2 days later. DISCUSSION: Platelets secrete serotonin, which mediates vasoconstriction through stimulation of 5-HT2a receptors. This is counterbalanced by the release of the vasodilator nitric oxide upon serotonin stimulation of endothelial 5-HT1 receptors. In conditions such as atherosclerosis, the damage to the endothelium leads to a greater vasoconstrictive response. Paroxetine has been reported to weakly inhibit norepinephrine reuptake and nitric oxide production in addition to increasing serotonergic activity, potentially compounding the vasoconstrictive response. An objective causality assessment revealed that the TIA was probably an adverse event resulting from use of paroxetine. CONCLUSIONS: Use of paroxetine and other selective serotonin-reuptake inhibitors may result in changes of the vasculature and subsequent ischemic events in predisposed patients.

Anticoagulants↗