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Results for “Transient ischemic attack”

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At least 487 records · Page 27Linked to original sources
PubMed2005

Perindopril-based blood pressure-lowering reduces major vascular events in patients with atrial fibrillation and prior stroke or transient ischemic attack.

BACKGROUND AND PURPOSE: Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. METHODS: This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)--a randomized, placebo-controlled trial that established the beneficial effects of blood pressure--lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg indapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, cause-specific vascular outcomes, and death from any cause. RESULTS: There were 476 patients with atrial fibrillation at baseline, of whom 51% were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38% (95% confidence interval [CI], 6 to 59) reduction in major vascular events and 34% (95% CI, -13 to 61) reduction in stroke. The benefits of blood pressure-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hypertension (P homogeneity=0.4). CONCLUSIONS: For most patients with atrial fibrillation, routine blood pressure-lowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.

Aged↗
PubMedDate not supplied

Transient ischemic attacks and external carotid artery. A retrospective study of 23 patients with an occlusion of the internal carotid artery.

Twenty-three patients with occlusion of an internal carotid artery have been followed 5 to 50 months after angiography. None had a later permanent stroke. Eight had delayed TIAs in the occluded internal carotid area, never in another area. In these TIAs the role of the homolateral external carotid artery is emphasized, because in the 8 cases this artery was the main collateral to the occluded internal carotid, and angiography had shown atheromatous stenosis of homolateral external/common carotid arteries or an irregular stump at the site of the occlusion. Hemodynamic and embolic mechanisms are discussed, especially the latter, because of the absence of severe stenosis and evidence of emboligenic plaques.

Adult↗
PubMedDate not supplied

CT and arteriographic comparison of patients with transient ischemic attacks--correlation with small infarction of basal ganglia.

Fifty patients presenting clinically with TIAs were examined angiographically. Twenty one patients (42%) had no abnormality. Twenty patients (40%) had stenosis or occlusion in the MCA, ACA or intracranial carotid, whereas 11 (22%) had involvement of their extracranial internal carotid artery. Seven of the 28 CTs performed showed basal ganglia infarcts. This suggests that the cause for the TIA was an infarct in the vascular territory of a lenticulostriate artery.

Basal Ganglia↗
PubMedDate not supplied

Cerebral angiographic and clinical differences in carotid system transient ischemic attacks between American Caucasian and Japanese patients.

Cerebral angiographic findings of 32 Japanese patients with carotid system TIA's were compared with those of an equal number of age and sex matched American Caucasians. The end points included irregularity, ulceration, stenosis or occlusion of the carotid artery appropriate to the side of TIA. Atherosclerotic changes were found in 27 patients (84.4%) of the Japanese and 30 patients (93.7%) of the American patients. Mild lesions (49% stenosis and below) were similar in either frequency of topography between both groups; namely 25 intracranial and 17 extracranial lesions in Japanese as well as 29 intracranial and 10 extracranial in Caucasian patients. There was, however, an extra-intracranial difference in severe lesions (50% stenosis and above) between American Caucasian and Japanese patients; 10 of 12 severe lesions in Japanese were located intracranially, while 17 of 20 severe lesions present in the American group occurred in the extracranial portion of the internal or common carotid arteries.

Adult↗
PubMedDate not supplied

Diagnosis of transient ischemic attacks: improvement of interobserver agreement by a check-list in ordinary language.

To try and improve the interobserver agreement for the diagnosis of TIA, we used a checklist in which the symptoms were recorded in plain language, instead of in abstract diagnostic terms such as amaurosis fugax. Criteria for a diagnosis of TIA were similarly phrased and recommended to all observers. Eight senior neurologists and ten neurology residents interviewed 72 patients in random pairs. In 64 cases the observers agreed on the diagnosis (kappa value = 0.77). After a short discussion between the two observers the agreement increased to a maximum (kappa = 1.0). However, in 29 of the 144 interviews the diagnosis would have been different, had the recommended criteria been fully applied. In 28 of these the observer had diagnosed TIA on insufficient evidence. Six "misinterpretations" led to disagreement for the diagnosis and only these were corrected by the observers during their discussion. The present design has led to a maximal agreement for the diagnosis of TIA between two observers, but the agreement between such a pair and the common diagnostic criteria was not yet ideal. The precision of the diagnosis could be improved if details of the required symptoms are discussed in general as well as for each patient.

Adult↗
PubMedDate not supplied

Cerebral vasoconstrictor responses to serotonin after dietary treatment of atherosclerosis: implications for transient ischemic attacks.

Serotonin, which is released when platelets aggregate at carotid lesions, may contribute to cerebral ischemia. Our goal was to test the hypothesis that dietary treatment of atherosclerosis reverses the augmented cerebral vasoconstrictor response to serotonin. We studied normal cynomolgus monkeys, atherosclerotic monkeys, and atherosclerotic monkeys that were fed a normal (regression) diet for 18 months. Morphometric studies indicated that the regression diet reduced intimal area in the carotid arteries by about 50-75%. Cerebral blood flow was measured with microspheres, and microvascular pressure was measured with a micropipette in pial arteries that were approximately 300 micron in diameter. Values for cerebral blood flow and arteriolar pressure were used to calculate resistance of large cerebral arteries (greater than 300 micron diameter). Infusion of serotonin produced a modest increase in the resistance of large cerebral arteries in normal monkeys. Vasoconstrictor responses to serotonin were increased more than fivefold in atherosclerotic monkeys. The major finding of the study is that dietary treatment of atherosclerosis abolishes augmented cerebral responses to serotonin.

Animals↗
PubMed1991

Recurrent transient ischemic attacks and stroke in association with an internal carotid artery web.

Fibromuscular dysplasia is a nonatherosclerotic vascular disease that most commonly affects cervical carotid arteries at the C1-C2 level when cephalic arteries are involved. Several histopathologic and angiographic subtypes of fibromuscular dysplasia exist; most have a benign natural history. We describe the third reported case of a pathologically proven, symptomatic proximal internal carotid artery web and suggest that patients with this lesion are at a higher risk for stroke.

Adult↗