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Results for “Transient ischemic attack”

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PubMed2003

Clinical characteristics in transient ischemic attack patients with atrial fibrillation.

OBJECTIVE: The aim of this study was to clarify the characteristics of transient ischemic attack (TIA) patients with atrial fibrillation (AF) compared to those without. METHODS: We divided 67 TIA patients with left hemispheric involvement into two groups; patients with AF (AF group) and without AF (Non-AF group) and compared the clinical characteristics between the two groups. PATIENTS: AF group included 12 patients (73.0 +/- 9.7 years old) and the Non-AF group 55 patients (64.1 +/- 9.8 years old). RESULTS: Clinically, arterial disease was less frequently seen in the AF group than in the Non-AF group (17% vs 53%, p = 0.028). No significant differences were observed between the two groups in the duration (< 1 hour; AF vs Non AF group: 50% vs 32%) or number of TIAs (more than 1; 17% vs 37%), use of anticoagulation or antiplatelet at time of symptom onset (34% vs 14%), past history of stroke and TIA (58% vs 38%) and ischemic heart diseases (8% vs 13%), and risk factors for atherosclerosis including hypertension (42% vs 71%), diabetes mellitus (17% vs 31%), hyperlipidemia (17% vs 47%), smoking (50% vs 51%) and other emboligenic cardiac diseases except for AF (0% vs 4%). Aphasia was observed more frequently in the AF group than in the Non-AF group (67% vs 20%, p = 0.003), whereas, hemiparesis without aphasia was seen less frequently in the AF group than in the Non-AF group (17% vs 55%, p = 0.025). CONCLUSION: TIA patients with AF are more likely than those without AF to exhibit a major hemispheric syndrome, such as aphasia.

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PubMed2004

Transient ischemic attacks: Part II. Treatment.

Risk factors for stroke should be evaluated in patients who have had a transient ischemic attack. Blood pressure, lipid levels, and diabetes mellitus should be controlled. When applicable, smoking cessation and weight loss also are important. Angiotensin-converting enzyme inhibitor therapy may help prevent stroke. Aspirin is the treatment of choice for stroke prevention in patients who do not require anticoagulation. Clopidogrel is an alternative therapy in patients who do not tolerate aspirin. Atrial fibrillation, a known cardioembolic source (confirmed thrombus), or a highly suspected cardioembolic source (e.g., recent large myocardial infarction, dilated cardiomyopathy, mechanical valve, rheumatic mitral valve stenosis) are indications for anticoagulation.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2004

Postoperative transient ischemic attack complicated by CO2 retention and hypoxemia in a patient receiving meperidine injection for postoperative pain relief.

Transient ischemic attack (TIA) or stroke is not a rare complication, particularly in aged patients after surgery and anesthesia. If it is not properly managed, unmendable injury may inevitably occur. Patients who experience postoperative TIA or stroke usually have underlying diseases without resolution or good control. We bring forward here for discussion a fatality due to unappropriately managed TIA, which occurred in a 72-year-old male, within 24 hours after surgery. Besides making accurate diagnosis, selection of drugs for pain relief and appropriate overall management are key points of discussion.

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PubMed1978

Cooperative study of hospital frequency and character of transient ischemic attacks. VIII. Risk factors.

A total of 969 (73%) of 1,328 patients with cases of suspected transient ischemic attacks (TIAs) who came to six institutions during a 21-month period were followed up. Factors were identified and prospectively analyzed for risk for further TIAs, stroke, and deatn. A history of multiple carotid artery TIAs was significantly related to further TIAs. A single TIA placed the patient at greater risk for early infarction. Older age, male sex, and unreliability to take dangerous medication were risk factors for cerebral infarction. Anticoagulant therapy, older age, male sex, diabetes mellitus, heart disease, abnormal ECG, and poor surgical risk were factors for death. The increased mortality associated with anticoagulants was confined to the older age group. While white patients treated with antiplatelet-aggregating agents had a lower mortality than those treated otherwise, this was not true amont black patients.

Age Factors↗

PubMed1993

Predictors of major vascular events in patients with a transient ischemic attack or nondisabling stroke. The Dutch TIA Trial Study Group.

BACKGROUND AND PURPOSE: Very few studies have addressed the identification of prognostic factors in patients with a transient ischemic attack or minor stroke. METHODS: We prospectively studied the prognostic value of clinical, laboratory, radiological, and electrocardiographic findings in 997 patients with a transient ischemic attack and 2,130 patients with a minor stroke who were entered into a multicenter clinical trial. The mean follow-up period was 2.6 years. RESULTS: A total of 302 patients died (212 from a vascular cause), 272 had a stroke, and 200 had a cardiac event. By means of a multivariate analysis we identified the following independent risk factors for stroke, myocardial infarction, or vascular death: age of > 65 years; male sex; dysarthria; multiple attacks; diabetes; angina pectoris; intermittent claudication; computed tomographic evidence of any cerebral infarct, especially a border zone infarct or white matter hypodensity; and electrocardiographic evidence of an anteroseptal infarct, ST depression, left ventricular hypertrophy, or left atrial conduction delay. Protective predictors were monocular attacks only or the presence of rotatory dizziness. CONCLUSION: A limited number of easily obtainable characteristics are powerful predictors of major vascular events in patients with cerebral ischemia.

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PubMed1987

Early brain-stem auditory evoked responses in vertebrobasilar transient ischemic attacks.

Brain-stem auditory evoked response (BAER) studies were performed one to 16 days after a vertebrobasilar transient ischemic attack (VB TIA) in eight patients and repeated two to 16 days later in six of them. Initially, all showed absence of waveforms, prolonged interpeak latencies, and/or amplitude reduction. Five of six patients showed reversal of BAER changes to normal; the remaining patient returned to near normal. Normalization occurred six to 24 days after the VB TIA. These results are different from those reported in other studies. Early sequential BAER studies may be helpful in differentiating VB TIA from brain-stem infarction and syndromes that mimic VB TIA.

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PubMed2004

Limb shaking transient ischemic attack--an unusual presentation of carotid occlusive disease. A case report and review of the literature.

Limb shaking transient ischemic attack (TIA) is an uncommon presentation of carotid occlusive disease. This unusual form of TIA is not well recognized and may be mistaken for focal epilepsy, delaying proper diagnosis and treatment. In this communication, we present such a case, together with a review of the literature, a brief account of pathophysiology and an outline of appropriate clinical management.

Carotid Stenosis↗

PubMed2002

Adherence to practice guidelines for transient ischemic attacks in an emergency department.

OBJECTIVE: To evaluate the investigation and treatment of patients with a diagnosis of transient ischemic attacks (TIA) in the emergency department (ED) a tertiary care teaching hospital with a neuroscience referral program. METHODS: A chart review was conducted in the hospital. Consecutive ED charts with a diagnosis of TIA were included; each was reviewed by independent coders using a standardized data form. RESULTS: Two hundred and ninety-three TIA charts were reviewed; the gender ratio was 1:1 with a mean age of 66 years. Most patients (75%; 95% CI: 70, 80) were evaluated by ED physicians; the remaining patients were seen directly by referral services. The median time from symptom onset to ED arrival was 29 hours and the duration of symptoms was 4.6 hours. Most patients received CT scans (81%; 95% CI: 73, 85), complete blood counts (74%; 95% CI: 68, 79), and electrocardiograms (75%; 95% CI: 70, 80) in the ED. In 16% (95% CI: 13, 22) a carotid doppler was performed and in 26% (95% CI: 21, 31) an outpatient doppler was booked. Among those who were discharged (75%; 95% CI: 70, 80), antithrombotic medications were not prescribed to 28% (95% CI: 22, 34). CONCLUSION: Practice variation exists with respect to the investigation and treatment of TIAs in this tertiary-care teaching hospital. Carotid doppler investigation and use of anti-platelet therapy for patients with TIA are suboptimal. Clinical practice guidelines and rapid assessment TIA clinics may change these results.

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PubMed2003

Head computed tomography findings predict short-term stroke risk after transient ischemic attack.

BACKGROUND AND PURPOSE: Current guidelines recommend the use of head CT in the evaluation of patients with transient ischemic attack (TIA), but data supporting its value are sparse. METHODS: Patients who presented to 1 of 16 emergency departments of a large Northern California health maintenance organization and received a diagnosis of TIA from November 1997 through February 1998 were enrolled and followed up for 90 days. Clinical, demographic, and outcome data were obtained from computerized databases and medical records. Physicians blinded to patient characteristics and outcomes abstracted head CT findings from radiology reports. Abstracted findings included evidence of old or new infarct, periventricular white-matter disease, cerebral atrophy, cerebral vascular calcification, and nonischemic lesions. RESULTS: Head CT was performed in 67% of eligible patients (n=322) diagnosed with TIA. Evidence of a new infarct was seen on head CT in 13 patients (4%). A nonischemic cause of TIA symptoms was found in 4 patients (1.2%). During follow-up, 10.9% of TIA patients experienced subsequent stroke. After adjustment for confounders, risk for stroke during follow-up was significantly higher in those with a new infarct on head CT compared with others with TIA (odds ratio, 4.06; 95% confidence interval, 1.16 to 14.14; P=0.028). Old infarction, periventricular white-matter disease, cerebral atrophy, and cerebral vascular calcification were not predictors of subsequent risk of stroke. CONCLUSIONS: Evidence of a new infarct on head CT in patients presenting with TIA is associated with increased short-term risk for stroke. Head CT appears to have prognostic value in patients with TIA and, for this reason alone, may be justified in their evaluation.

Adult↗

PubMedDate not supplied

Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis.

In a group of 132 patients with transient ischemic attacks ((TIAs) 7 patients (4 men, 3 women, ages 64 to 81) had TIAs preceded by hypotension. The average fall of mean blood pressure during an attack was 26.4 +/- 5.5 mm Hg (SD). Only one of these patients had a TIA which was not preceded by hypotension. This episode occurred during a paroxysm of coughing. All 7 of these patients had hypertension, and cerebral arteriography performed in 4 of the 7 revealed hemodynamically significant carotid artery stenosis. Each of the 4 patients developed hypotension and a TIA after the procedure. Twenty of the other patients had hypotensive episodes but did not develop focal neurological deficits. None of these patients had carotid artery stenosis. This study suggests that hypertensive patients with carotid artery stenosis may be at risk to develop focal cerebral ischemia during acute hypotensive episodes.

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PubMed1988

Transient ischemic attacks and normal cerebral angiograms: a follow-up study.

To determine the outcome of patients with carotid transient ischemic attacks (TIAs) and normal cerebral angiograms, we assessed 68 patients (40 men, 28 women) aged 24-72 (mean 53.5) years for recurrent TIAs and strokes and for the development of cardiac disease over 2-6 (mean 4.4) years. All but one patient had a follow-up interview in early 1987; that patient had died of an unrelated cause (lung cancer) 18 months after the presenting TIA. The diagnosis was changed at the follow-up interview in three patients (multiple sclerosis, meningioma, migraine). Among the 64 remaining patients, at admission cranial computed tomography had shown cerebral infarction in 11 of 64, two-dimensional echocardiography had been abnormal in nine of 61, Holter monitoring had been abnormal in eight of 45, and twelve-lead electrocardiography had been abnormal in three of 64. Two patients had abnormalities on both echocardiography and Holter monitoring. At the follow-up interview of the 64 remaining patients, TIAs had recurred in nine and three had developed a completed stroke; cardiac disease (angina in seven, myocardial infarction in four) was noted in 11 patients. Findings from cardiac investigations on admission in the nine patients with recurrent TIAs had been abnormal in six and normal in three; all three patients who developed a stroke had had abnormal cardiac findings. Overall, further neurologic or cardiac events occurred in 12 of 46 patients (26%) with normal and in 10 of 18 patients (55.5%) with abnormal findings on admission (p less than 0.01). In the presence of normal angiograms, extensive cardiac investigations may help predict the outcome of patients with TIAs.

Adult↗

PubMed1998

Incidence of transient ischemic attack in Rochester, Minnesota, 1985-1989.

BACKGROUND AND PURPOSE: There is scant information available on the incidence of transient ischemic attack (TIA) in a defined population. This study defines incidence rates of first TIA and subtypes of TIA during 1985-1989 and compares the incidence to that obtained from a 1960-1972 cohort study. METHODS: Medical records of all residents of Rochester with potential diagnosis of TIA during 1985-1989 were screened to determine whether the case met the criteria for TIA. All available data were used to determine the vascular distribution of the TIA. Average annual age- and sex-adjusted incidence rates were calculated for 1985-1989, and results were compared with incidence rates determined in a Rochester-based 1960-1972 cohort study. RESILTS: Two hundred two cases of first TIA or amaurosis fugax occurred among Rochester residents during 1985-1989. The age- and sex-adjusted incidence rate for any TIA was 68/100 000 population. Incidence of amaurosis fugax was 13/100 000; anterior circulation (cerebral) TIA, 38/100 000; and vertebrobasilar distribution TIA, 14/100 000. Rates were similar to those determined from a 1960-1972 cohort study. CONCLUSIONS: The incidence rate of TIA is 41% that of stroke incidence. TIA incidence in Rochester, Minn, is higher than has been previously reported for other sites throughout the world. Although comparison with prior time periods is difficult because of ascertainment issues, it appears that there has been no significant change in TIA incidence since the decade of the 1960s or earlier. This suggests that the most common mechanism for TIA (atherosclerosis) has not changed in prevalence, nor have risk factors leading to this mechanism.

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PubMed2000

A population-based study of transient ischemic attack incidence in Novosibirsk, Russia, 1987-1988 and 1996-1997.

BACKGROUND AND PURPOSE: Population-based data on transient ischemic attack (TIA) incidence are scarce. This study defines incidence rates of first-ever TIA in Novosibirsk, Russia, during 1987-1997 and compares the incidence of first TIA with that of first stroke. METHODS: This is a prospective registry population-based study of all new cases of TIA and stroke in an overall population of 455 765 residents of Novosibirsk. All new TIA and stroke incident cases (whether inpatient or outpatient) that occurred during 1987-1988 and 1996-1997 study periods were recorded and analyzed. A 95% CI was estimated for all age- and sex-specific strata. RESULTS: During the 2 study periods, a total of 211 patients with first TIA were registered in the population studied. The crude annual TIA incidence rate per 100 000 residents was 16 (95% CI, 8 to 33) in 1987-1988 and 29 (95% CI, 9 to 87) in 1996-1997; these rates standardized to the European population were 17 (95% CI, 8 to 34) and 27 (95% CI, 9 to 79), respectively. Eighty-three percent of TIAs occurred in the carotid arteries (rate, 48/100 000), 10% occurred in the vertebrobasilar territory (rate, 6/100 000), and 7% of cases had a TIA of uncertain distribution (rate, 2/100 000). CONCLUSIONS: Unlike stroke incidence rate, the incidence rate of TIA in Novosibirsk is similar to that in other populations and constitutes approximately 10% of stroke incidence. For the last decade (1987-1997), there was a tendency, although statistically insignificant, toward increasing incidence rate of TIA in the population studied.

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PubMed1991

Clinical characteristics of transient ischemic attacks in black patients.

We analyzed the clinical, CT, and angiographic findings in 50 black patients with carotid transient ischemic attacks (TIAs). Thirty-two percent had TIAs lasting less than 1 hour, 26% had TIAs lasting 1 to 6 hours, and 42% had TIAs lasting 6 to 24 hours. Fifty-two percent of TIA patients had CT evidence of cerebral infarction despite complete clinical recovery. CT was abnormal in two of 16 (13%) patients with TIAs lasting less than 1 hour; however, CT was abnormal in 24 of 34 (70%) patients with TIAs lasting longer than 1 hour. Angiographic findings of extracranial carotid disease appropriate to TIA symptoms were present in 12 (24%) patients. Two patients in whom the TIA episode lasted less than 1 hour later had clinical cerebral infarction, whereas 20 patients with longer-duration TIAs developed ischemic stroke within 4 months. Of these black TIA patients, 22 (44%) developed clinical cerebral infarction.

Adult↗

PubMed1985

Selective conventional arteriography and computed tomography with and without contrast infusion: minimal requirements for the assessment of transient ischemic attacks.

The authors report two unusual cases referred for extracranial bypass surgery. These patients presented with symptoms of transient ischemic attacks (TIAs) and demonstrated the necessity of conventional selective angiography and computed tomography (CT), with and without contrast infusion, as part of the preoperative assessment. The authors discuss how digital subtraction angiography alone is inadequate and how CT without contrast enhancement may fail to visualize lesions that may exhibit TIA-like symptoms. In the face of the multiplicity of preoperative tests used to evaluate patients with TIA symptoms, the authors stress the importance of selective conventional angiography and CT with and without contrast administration.

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PubMed1979

Transient ischemic attacks due to increased platelet aggregation and adhesiveness. Ultrastructural and functional correlation.

The authors report 22 cases of transient ischemic attacks (TIA's) manifested by amaurosis fugax or hemiparesis or paresthesia of less than 24 hours' duration. None of the patients demonstrated 1) evidence of atherosclerotic cerebral vascular disease on angiography, 2) evidence of intracranial lesion on brain scan, 3) cardiac source of emboli, 4) arteritis or collagen disease, or 5) history of migraine. The only abnormalities found to explain the TIA's were abnormally increased platelet adhesiveness and/or aggregation. All of these patients were followed from 1 to 5 years, and had repeated coagulation studies. Treatment with antiplatelet drugs showed an excellent clinical response with associated decrease in platelet adhesiveness and aggregation. Discontinuance of the antiplatelet drug resulted in a recurrence of the TIA's which coincided with an increase in aggregation and adhesiveness. In two cases the platelet morphology was studied by transmission and scanning electron microscopy. It appears that there is a specific group of patients with TIA's in whom the sole cause of the attack is an abnormality of platelet function. For these people there is a specific therapy and a method monitoring the treatment.

Adolescent↗

PubMed1988

Carotid endarterectomy in patients with territorial transient ischemic attacks.

Results are presented of a retrospective analysis of 651 carotid endarterectomies in 605 patients with carotid territorial transient ischemic attacks (TIAs). All operations were performed by the same surgeon in a community hospital from 1963 to 1986. Arteriographic findings consisted of carotid stenosis of 50% or greater in 88.5% of patients and stenosis less than 50% and/or an ulcerated plaque in the remaining 11.5%. Medical risk factors were detected in 92% of patients; hypertension, peripheral vascular disease, and coronary atherosclerosis were most prevalent. All operative procedures were conducted with the patients under general anesthesia, routine shunting, and arterial closure without a patch. The perioperative stroke rate was 1.5% (10 patients); the morality rate was 0.8% (three deaths from myocardial infarction and two from stroke) for a combined stroke and mortality rate of 2.0% (13 of 605 patients). Follow-up (mean 61.8 months) was possible in 570 (96%) of the patients surviving operation without a perioperative stroke. The cumulative probability of late stroke (i.e., cerebral infarct ipsilateral to the operated artery) was 2.5% at 5 years and 8.1% at 10 years. When the perioperative stroke-mortality rate (2.0%) is combined with the data for late ipsilateral stroke, the 5- and 10-year probabilities of ipsilateral stroke were 4.5% and 9.9%, respectively (mean 1% per year for 10-year period). Coronary atherosclerosis accounted for 43% of late deaths and 16% of strokes. The perioperative stroke-mortality rate of 2.0% in this group of patients falls within the acceptable range for carotid endarterectomy in patients with TIA.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1984

Improvement of cerebral blood flow and/or CO2 reactivity after superficial temporal artery-middle cerebral artery bypass in patients with transient ischemic attacks and watershed-zone infarctions.

The effect of extracranial-intracranial bypass anastomosis on cerebral blood flow and CO2 reactivity during hypocapnia was investigated in ten patients with transient ischemic attacks or watershed infarctions due to carotid occlusive diseases. Six patients had occlusion and four had stenosis (greater than 50%) of the internal carotid artery. Those with infarctions had increased cerebral blood flow and CO2 reactivity postoperatively, and improved clinically. Those with transient ischemic attacks due to stenosis (greater than 50%) of the internal carotid artery had increased CO2 reactivity postoperatively but constant normal regional blood flow. Cerebral blood flow improved in those with poorer flow, CO2 reactivity increased in those with better reactivity, and better CO2 reactivity preoperatively brought about a greater flow increase. The pre- and postoperative evaluation of cerebral blood flow and CO2 reactivity is believed to be useful in evaluating the effectiveness of bypass anastomosis. Preoperative evaluation might be informative in selecting candidates for bypass.

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