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PubMed2002

Management of stroke and transient ischemic attack.

Stroke is a major cause of death and disability. The resulting burden on society continues to grow, despite recent advances in acute stroke therapy. Thrombolysis reduces stroke morbidity but is only applicable to a small percentage of stroke patients. Acute stroke units, which allow for the greatest overall improvement in outcome, provide the best facilities for acute intervention. Despite recent advances in acute management, such as endarterectomy and anticoagulation, primary and secondary preventive measures to control stroke risk factors, along with appropriate specific interventions, are the key to reducing the overall burden of stroke.

Acute Disease↗
PubMed1975

Transient ischemic attacks.

The treatment of TIA must be individualized. TIA is one of several manifestations of generalized atherosclerosis. While one-third of patients with TIA will suffer a stroke in five years, one-half of the same group will die of myocardial infarction. The risk of stroke is greater in carotid rather than vertebral-basilar TIA, in older patients, and in those with a cluster of TIAS, an is highest in the first month after the TIA. Treatment should reflect this knowledge.

Anticoagulants↗
PubMed2003

[Prevalence of structural abnormalities of the atrial septum and their association with recent ischemic stroke or transient ischemic attack: echocardiographic evaluation in 18631 patients].

BACKGROUND: Ischemic stroke is one of the most frequent causes of morbidity and mortality in industrialized countries. In more than 40% of cases the cause of the ischemic event is not recognized, especially in young patients in whom, moreover, the presence of a structural abnormality of atrial septal aneurysm (ASA) and patent foramen ovale (PFO) is more frequently reported. The prevalence of this two minor atrial septal defects is strongly related to the study population (unselected patients and patients with recent ischemic stroke/transient ischemic attack-TIA) and to the diagnostic tool employed (transthoracic echocardiography--TTE or transesophageal echocardiography--TEE). METHODS: We retrospectively evaluated the prevalence of ASA in 16,836 patients who underwent TTE from January 1, 1994 to June 30, 2002. During this time period we also evaluated the prevalence of ASA, PFO and their association in 1795 patients in whom a TEE was performed. The patients who underwent TEE were divided into two groups: group A included 430 patients with recent stroke/TIA or suspect cardioembolic event, and group B included 1365 patients as controls. RESULTS: An ASA was detected in 1.6% of the whole study population; 0.7% of the patients underwent TTE and 10.2% of the patients underwent TEE. In group A the prevalence of ASA was 24%, in group B 4.7% (p < 0.001). A PFO was identified in 9.9% of patients in whom a TEE was performed; the rate was 24% in group A and 5.3% in group B (p < 0.001). In a subgroup of 65 patients, < 60 years (mean age 45 +/- 8 years), with cryptogenic or unexplained stroke/TIA a TEE examination identified the presence of ASA, PFO and their association in a rate of 20, 15 and 34%, respectively. CONCLUSIONS: Our data show, in a large study population, a prevalence of ASA and PFO not negligible. The association of this two atrial septal abnormalities in patients with stroke/TIA, especially those classified as cryptogenic, suggests to study in depth these minor atrial septal defects and in particular: 1) to standardize ASA definition; 2) to identify the etiopathogenetic mechanisms leading to embolic events; 3) to define the best pharmacological treatment.

Adult↗
PubMed1992

Parenchymal "damage" in transient ischemic attacks (TIAs) and prolonged reversible ischemic neurologic deficits (PRINDs):--the role of cranial CT and EEG.

Over a period of 6 years (1985-1990) we reviewed records of patients with one or more TIAs or PRINDs (196 TIAs, 63 PRINDs). 111 patients (42.9%) suffered from TIAs/PRINDs of the anterior circulation. In all cranial CT scanning (CCT) was performed, whereas only in 79 EEG was recorded after recovery from the symptoms. 25 patients (22.5%) out of the 111 showed low density areas of recent onset in CCT made responsible for the attack. Among the EEGs of the 79 patients 35 (44.3%) revealed corresponding electrical abnormalities. Out of the 79 patients investigated by both methods in 14 (17.7%) a lesion was demonstrated in CCT and focal abnormality in EEG. In 11 (13.9%) EEG was normal despite a lesion manifested in CCT. Vice versa 21 patients (26.6%) showed normal CCTs but focal abnormalities in EEG. By far most cases (43%) had normal CCTs and EEGs. These results may contribute to a redefinition of TIA and PRIND as clinically defined syndromes in prae-CT-area.

Amnesia↗
PubMedDate not supplied

Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging.

BACKGROUND: Diagnosing TIA can be difficult, since evidence of brain ischemia is habitually lacking on CT and conventional MR imaging. It has been suggested that patients with acute brain infarction on neuroimaging should be considered stroke cases instead of TIA, regardless of duration of symptoms, implying that optimal diagnostic methods need to be utilized. We therefore postulated that perfusion-weighted MR imaging (PW imaging) would be useful in the diagnosis of TIA. METHODS: Retrospective analysis of 22 patients with reversible neurologic symptoms lasting less than 24 hours, assessed with DW and PW imaging. RESULTS: MR imaging was abnormal in 15 patients (68%): 12 had abnormal DW imaging, four had both DW and PW imaging defects (all with a mismatch) and three had an isolated PW imaging abnormality. There were no differences in symptom duration, stroke etiology or cardiovascular risk factors between patients with abnormal MR imaging and those with unremarkable scan. Patients with mismatch were more likely to need conventional angiography or other cerebrovascular procedures. CONCLUSION: The combined use of DW imaging and PW imaging provided evidence of brain ischemia in most patients with clinical diagnosis of TIA. Prospective studies using follow-up MR imaging are required to determine the outcome of affected tissue, as well as the clinical implications of DW-PW imaging abnormalities.

Aged↗