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At least 19 recordsLinked to original sources
PubMed2005

Evolving concepts regarding transient ischemic attacks.

Transient ischemic attack (TIA) represents one end of the spectrum of focal brain ischemia, the other being completed infarction or ischemic stroke. The evolving technologic advancements in neuroimaging continue to change and sharpen the definition, epidemiology, and management of TIA. As a powerful risk factor for ischemic stroke, TIA deserves widespread public and physician education, urgent attention and investigation, and rapid management. The recognition and treatment of TIA provides an excellent opportunity for stroke prevention that is often missed or poorly recognized among physicians.

Animals↗
PubMed1983

Transient ischemic attack, protracted transient ischemic attack, and completed stroke.

The natural history and follow-up (5-7 years) of 76 patients with transient ischemic attacks (TIA), 45 patients with protracted transient ischemic attacks (PTIA), 85 patients with minor strokes (labelled as partial nonprogressing stroke; PNS) has been studied with the purpose of a comparative evaluation, since TIA, PTIA and PNS are often grouped together. Multiple attacks significantly recurred more frequently in patients with TIA and PTIA with respect to those with PNS. Patients with PNS significantly survived the follow-up with respect to patients with TIA and PTIA. At present, the distinction into TIA, PTIA and PNS should be maintained. Vascular surgery in cases with PNS should not be regarded a reasonable therapeutic strategy except in some individual cases.

Aged↗
PubMed1991

[Prognosis after transient ischemic attacks].

Transient ischemic attacks (TIAs) are reversible neurological deficits due to cerebral ischemia in a vascular territory lasting less than 24 hours, usually less than one hour. The natural course of TIAs is variable. One third of the patients suffer from a subsequent completed stroke with lasting disability, one third of the patients continues to experience TIAs and in one third no further symptoms are encountered. TIAs are a warning symptom of a generalized vascular process, myocardial infarction being the most common cause of mortality and ischemic brain infarction being the most common cause of morbidity. Clinical parameters--besides age--seem to be of minor prognostic relevance. Vascular risk factors should be evaluated in all TIA patients; especially, a cardiac work up including 2D-echocardiography and an exercise stress test should be performed. Duplex sonography of craniocervical vessels shows atherosclerotic lesions in a considerable proportion of patients with TIA; however, localization of these lesions does not always correspond to clinical symptomatology. Some angiographic features are of prognostic relevance. Computed tomography (CT) and magnetic resonance imaging (MRI) show ischemic lesions in a considerable proportion of patients, which connects TIAs directly to ischemic brain infarcts. The extent and localization of these lesions are of some prognostic relevance. Blow flow studies on single photon emission computed tomography (SPECT) and studies of brain metabolism on positron emission tomography (PET) are abnormal in many TIA patients for prolonged periods and also have some prognostic impact. TIA patients probably are a heterogeneous group with a common symptom. A detailed diagnostic work-up may have implications on a more specific and efficient therapy.

Aged↗
PubMed1995

[Prognosis of and basis for decision making in transient ischemic attacks].

Transient ischemic attacks are frequently seen in physicians' daily clinical practice. TIA's are often a warning sign of a following stroke. It is important to diagnose the underlying etiology in order to prevent subsequent stroke. With knowledge of the exact etiologic diagnosis correct secondary preventive therapy may be given. Most patients have atherosclerotic cerebrovascular disease. The aim of this procedure is to save patients from disabling strokes. There is no need to hospitalize patients in the absence of severe comorbidity.

Aged↗
PubMed1994

Evaluation of the patient with transient ischemic attacks.

Transient ischemic attacks (TIA) are warning symptoms of stroke in 35% of patients. A TIA is an episode of focal neurological dysfunction which is of sudden onset; the deficit completely resolves within 24 hours but the majority of TIA episodes last only 5 to 30 minutes. Full neuroimaging and neurovascular evaluation are necessary for all TIA patients. The occurrence of a TIA represents a medical emergency and immediate evaluation is necessary to define the occurrence of TIA mechanism and determine appropriate treatment options to avoid the development of a completed stroke.

Humans↗
PubMed1995

[Assessment and diagnosis of transient ischemic attacks].

Transient ischemic attacks (TIA) are defined as acute, retinal or focal-cerebral neurological symptoms, resulting from vascular disease, which resolve in less than 24 hours. Typical clinical signs are transient visual obscuration, sudden weakness of one arm or leg, loss of speech, and dizzy spells. These patients run a considerable risk of stroke; hence rapid diagnosis and treatment are mandatory. Differential diagnosis includes transient global cerebral function loss, non-vascular transient focal attacks, as well as extracerebral causes of transient neurological symptoms. The following basic investigations are necessary for most patients with TIA: simple laboratory work-up, extra- and transcranial doppler/duplex-ultrasonography, cardiological examination and CT-scan. Angiography and MR-angiography are reserved for specific questions.

Brain Diseases↗
PubMed1987

Clinical evaluation and management of transient ischemic attacks.

Transient ischemic attack (TIA) is a common but poorly understood disorder. Although it rightfully has been classified as a major risk factor for stroke, the majority of patients with TIAs do not suffer subsequent stroke, and it is unclear whether aggressive evaluation and treatment of TIA will significantly lower stroke risk. To effectively treat this disorder, the implications of transient cerebral ischemia and the basic pathophysiologic process underlying this condition must be understood, as well as the myriad of specific clinical causes that must be considered in any patient. Any less sophisticated approach will only propagate the confusion that already exists and lead to the use of therapies that may be useless or even harmful.

Cerebrovascular Disorders↗
PubMedDate not supplied

Treatment program and comparison between anticoagulants and platelet aggregation inhibitors after transient ischemic attack.

Transient cerebral ischemic attacks (TIA) are an important warning symptom of threatening stroke from cerebral infarction (CI). A local treatment program aimed at identifying as many individuals with TIA as possible and treating them in a uniform manner is desirable. Platelet aggregation inhibitors with a combination of acetylsalicylic acid and dipyridamole (ASA + DP) has been compared with anticoagulants (AC). The average length of treatment was 24 months and all patients received the treatment for at least 6 months. Sixty patients received AC and 65 ASA + DP. Four patients in the ASA + DP group (6 percent) and 2 in the AC group (3.3 percent) sustained cerebral infarction. These figures are essentially lower than the expected incidence of 15--20 percent.

Aged↗
PubMed1967

Management of transient cerebral ischemic attacks.

Transient ischemic attacks (TIAs) are brief reversible episodes of neurological dysfunction due to temporary focal cerebral ischemia. Angiography should be performed only when operation is indicated or when the diagnosis is in doubt. Surgical treatment is recommended when the patient is a good surgical risk, when the stenosis is more than 70 per cent in the appropriate vessel and in certain patients with less severe stenotic lesions that appear to be a probable source of emboli. Anticoagulant therapy is indicated when there are recurrent TIAs, when the patient is not a good surgical candidate and when no appropriate surgically remediable lesion is found by angiography. If there is any significant contraindication to anticoagulants they should not be given. Discontinuance of anticoagulant therapy when the patient has been symptom-free for six months is recommended. In the experience of the authors the TIA syndrome is more benign in its course than was originally suspected and a conservative approach to surgical and anticoagulant therapy is recommended.

Aged↗
PubMed2005

Management of transient ischemic attack: 2005.

Transient ischemic attack is a common presenting problem to clinicians. Historically, these events were defined by the resolution of new neurologic symptoms within a 24-h time-frame; however, recent data suggests that a 1-h time frame is more appropriate. New imaging techniques and clinical evidence suggests that transient ischemic attacks present a higher risk of impending stroke than previously thought. This has led to a redefinition of what constitutes an attack, and also to a focus on both earlier investigation and treatment of correctable causes. New antiplatelet agents are now available and pose a challenge as to how they should be prescribed. Carotid endarterectomy is the standard of care for a subset of transient ischemic attack patients with significant carotid stenosis. Carotid angioplasty and stenting are more recent developments that may further expand treatment options.

Humans↗
PubMed2006

National Stroke Association guidelines for the management of transient ischemic attacks.

OBJECTIVE: Transient ischemic attacks are common and important harbingers of subsequent stroke. Management varies widely, and most published guidelines have not been updated in several years. We sought to create comprehensive, unbiased, evidence-based guidelines for the management of patients with transient ischemic attacks. METHODS: Fifteen expert panelists were selected based on objective criteria, using publication metrics that predicted nomination by practitioners in the field. Prior published guidelines were identified through systematic review, and recommendations derived from them were rated independently for quality by the experts. Highest quality recommendations were selected and subsequently edited by the panelists using a modified Delphi approach with multiple iterations of questionnaires to reach consensus on new changes. Experts were provided systematic reviews of recent clinical studies and were asked to justify wording changes based on new evidence and to rate the final recommendations based on level of evidence and quality. No expert was allowed to contribute to recommendations on a topic for which there could be any perception of a conflict of interest. RESULTS: Of 257 guidelines documents identified by systematic review, 13 documents containing 137 recommendations met all entry criteria. Six iterations of questionnaires were required to reach consensus on wording of 53 final recommendations. Final recommendations covered initial management, evaluation, medical treatment, surgical treatment, and risk factor management. INTERPRETATION: The final recommendations on the care of patients with transient ischemic attacks emphasize the importance of urgent evaluation and treatment. The novel approach used to develop these guidelines is feasible, allows for rapid updating, and may reduce bias.

Health Planning Guidelines↗
PubMed2003

Cognitive impairment in patients with carotid artery occlusion and ipsilateral transient ischemic attacks.

Although transient ischemic attacks (TIAs) by definition do not cause lasting neurological deficits, cognitive impairment has been suggested in patients with carotid artery disease who have suffered from a TIA. The purpose of our study was to assess whether patients with carotid artery disease and TIAs are cognitively impaired, to describe the frequency, nature and severity of this impairment, and to search for associated patient characteristics.Thirty-nine consecutive patients with carotid occlusion and ipsilateral cerebral or retinal TIAs, and 46 healthy controls underwent extensive neuropsychological assessment. Performances were compared group-wise with analysis of variance. In addition, the presence of cognitive impairment in the individual patient was determined. Associations between illness characteristics and cognitive impairment were explored with regression analysis.Fifty-four percent of patients were cognitively impaired. Cognitive deficits were non-specific in nature and mild in severity. Impairment occurred also in patients with isolated retinal symptoms and in those without visible ischemic brain lesions on MRI. Neither the presence of any vascular risk factor, the side of the symptomatic carotid occlusion, the uni- or bilaterality of carotid occlusion, nor the number of cerebral ischemic lesions were predictors of cognitive impairment. We conclude that about half of the patients with carotid artery occlusion and ipsilateral TIAs are cognitively impaired. The presence of cognitive deficits in patients with isolated retinal symptoms and in those without cerebral ischemic lesions on MRI argues against an exclusive role for structural brain damage in the pathogenesis of these deficits.

Adult↗
PubMed1996

Morbidity and mortality associated with transient ischemic attack (TIA).

Transient ischemic attack (TIA) is defined as "an episode of focal loss of brain function attributed to ischemia that lasts less than 24 hours, is localized to a portion of the brain supplied by one vascular system, has no persistent deficit, and is not attributable to any other cause." Most TIAs are caused by small thromboemboli that originate in atheromatous areas in neck vessels or the heart. Other mechanisms include nonatherosclerotic vascular diseases, mitral valve prolapse, hematologic diseases, and abnormal blood pressure fluctuations. Even in series of fully investigated cases, there remains a group in which no cause can be found. The great majority of TIAs are extremely brief. In one series, 24% ended within 5 minutes, 39% in 15 minutes, 50% in 30 minutes, and 60% in 1 hour.

Adolescent↗
PubMed1995

Clinical features and carotid duplex sonography in patients with carotid transient ischemic attacks.

BACKGROUND: Transient ischemic attack (TIA) is recognized as a precursor of cerebral infarction. It is prompted by an embolism from extracranial carotid artery disease. However, extracranial carotid disease is less prevalent in Chinese patients. Non-invasive duplex sonography has been used for initial screening for extracranial carotid artery disease. METHODS: One hundred and twenty-seven consecutive patients with carotid TIA were divided into two groups according to sonographic results, Group I: < or = 50%, and Group II: > 50% stenosis of the carotid artery. The two groups were compared for the clinical manifestations, risk factors, brain computed tomography (CT) findings and subsequent stroke. An age and sex-matched group of patients with lacunar stroke was also collected from the same neurosonological data bank for further comparative analysis. RESULTS: The mean age at onset was 59 +/- 12 (mean SD) years. Hypertension was the most common risk factor. The most common symptom was transient focal motor deficit (73%) with or without other complaints. Eighty-two percent of the TIA episodes were less than one hour in duration. In Group I, there were 114 patients (90%) with stenosis < or = 50% ipsilateral to the symptomatic side. Group II included only 13 patients (10%) with the ipsilateral carotid artery stenosis > 50%. Mean age was older and cigarette smoking was more common in Group II (p < 0.05). Otherwise, no significant difference was noted between the two groups in initial characteristics of TIAs, risk factors, brain CT findings or subsequent stroke. Further, there was no statistical significant difference between the TIA and lacunar stroke groups in the degree of carotid stenosis. CONCLUSIONS: Hypertension was the most common risk factor for carotid TIAs. The prevalence of extracranial carotid artery disease was low in Chinese patients with carotid TIAs. The severity of the carotid artery was not predictive of recurrence of TIA or of subsequent stroke. There was no significant difference between patients with TIA and with lacunar stroke in sonographic findings of extracranial carotid arteries.

Adult↗
PubMed2000

Time course of focal slow wave activity in transient ischemic attacks and transient global amnesia as measured by magnetoencephalography.

In this longitudinal study multichannel MEG was used to localize and to quantify focal pathological spontaneous neuromagnetic activity in six patients with transient ischemic attacks (TIA) and two patients with transient global amnesia (TGA). Slow (2-6 Hz) and beta (14-30 Hz) activity were monitored up to 10 weeks. Results were compared with normative data, and changes over time were statistically analyzed. MEG detected pathological activity that persisted clinical symptoms. Focal slow activity originating from sensorimotor (TIA) and mesiotemporal (TGA) cortices exceeded normal values up to 14 times during the first hours after the attack and recovered to normal within 11 days. Focal beta activity was not useful to monitor the time course of TIA or TGA.

Aged↗
PubMed2005

Cardiogenic embolism producing crescendo transient ischemic attacks.

Lateralizing, repetitive transient ischemic attacks are characteristic of symptomatic carotid bifurcation atherosclerotic plaques. We report a case in which a cardiogenic embolus, after lodging at the left carotid bifurcation, produced crescendo episodes of expressive aphasia and mild right upper extremity weakness. Complete neurological recovery was achieved following emergent carotid embolectomy and endarterectomy. This case demonstrates that the laminar nature of internal carotid blood flow may result in the localization of embolic events to a single region of the cerebral vasculature, regardless of the source lesion in the carotid artery. The role of endoluminal techniques in the diagnosis and management of such lesions is discussed.

Aged, 80 and over↗
PubMed2005

Primary study on imaging in transient ischemic attacks.

BACKGROUND: Although transient ischemic attacks (TIA) is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cerebral perfusion imaging and transcranial Doppler sonography (TCD) in patients with TIA. METHODS: Conventional CT, CT cerebral perfusion imaging and TCD were performed in 20 patients with TIA. After regular CT examination, 40-second dynamic scans were performed on selected slice, while 40 ml of non-ionic contrast materials was bolus-injected through antecubital vein with power injector. These dynamic images were processed with the perfusion software package on workstation. Cerebral blood flow (CBF) and time to peak (TTP) were measured in specific regions of the brain. TCD was also performed in 20 patients with TIA. Comparative analysis was made on the basis of the results of conventional CT, CT cerebral perfusion imaging and TCD. RESULTS: In the 20 patients with TIA, conventional CT turned out to be normal. However, persisting abnormal perfusion changes corresponding to clinical symptoms were found in 13 cases with the prolonged TTP. The other 7 cases were normal. TTP of the affected side (11.6 +/- 3.0) s was significantly prolonged (t = 4.782, P < 0.01) in comparison with the contralateral side (8.8 +/- 1.5) s. The difference in CBF was not statistically significant (t = 1.912, P = 0.073) between the affected side [(223.9 +/- 19.6) ml.min(-1).L(-1)] and the contralateral side [(227.7 +/- 19.8) ml.min(-1).L(-1)]. TCD revealed severe stenosis or occlusion of the carotid artery in 10 patients, arteriosclerosis in 6 patients, blood speed decrease in 2 patients, vasospasm in 1 patient. CONCLUSIONS: Conventional CT can exclude intracerebral diseases. Perfusion CT provides valuable hemodynamic information and shows the extent of perfusion disturbances. TCD can demonstrate abnormalities of the involved arteries in patients with TIA. The combination of these three imaging methods can provide more diagnostic information.

Adult↗