Transient Vestibular Symptoms Preceding Posterior Circulation Stroke

Background and Purpose: The recognition of clinical features of transient vestibular symptoms (TVSs) preceding posterior circulation stroke (PCOS) would be informative to discriminate dizziness/vertigo due to vertebrobasilar transient ischemic attack from the acute transient vestibular syndrome. We sought to determine the prevalence and characteristics of TVSs preceding PCOS. Methods: We performed a prospective multicenter observational study that had recruited 447 patients with PCOS from referral-based 4 university hospitals in Korea. We investigated the timing, pattern, frequency, duration, and accompanying neurological symptoms of TVSs during the 3 months preceding PCOS. Results: The prevalence of TVSs preceding PCOS was 12% (55/447) during the previous 3 months. The TVSs preceding PCOS occurred within 1 week (33%), between 1 week and 1 month (16%), or between 1 and 3 months (51%). The TVSs were mostly dizziness/vertigo with (36%) or without (60%) imbalance, while the remaining 4% had an isolated imbalance. The dizziness/vertigo was spinning in 38% and was aggravated during head position in 45%. The duration of TVSs was mostly a few seconds (55%) or minutes (38%). Approximately 72% of the patients with PCOS had TVSs 1 to 5 times, while 16% had >10 times. Accompanying neurological symptoms, including headache, tinnitus, limb weakness, sensory change, dysarthria, visual field defect, and diplopia, were reported in 11%. Conclusions: Preceding TVSs can occur in 12% of PCOS during the previous 3 months. Isolated dizziness/vertigo of unknown cause needs to be considered as a vertebrobasilar transient ischemic attack symptom, especially in patients with vascular risk factors. The characteristics of isolated vestibular symptom in vertebrobasilar transient ischemic attacks is highly variable and atypical compared with other transient ischemic symptoms.

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Visual field impairment predicts recurrent stroke after acute posterior circulation stroke and transient ischemic attack

CNS Neuroscience & Therapeutics ◽

10.1111/cns.12787 ◽

2018 ◽

Vol 24 (2) ◽

pp. 154-161 ◽

Cited By ~ 1

Author(s):

Yi-Ming Deng ◽

Duan-Duan Chen ◽

Lu-Yao Wang ◽

Feng Gao ◽

Xuan Sun ◽

...

Keyword(s):

Visual Field ◽

Transient Ischemic Attack ◽

Recurrent Stroke ◽

Posterior Circulation ◽

Posterior Circulation Stroke ◽

Ischemic Attack ◽

Visual Field Impairment

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Stroke Risk After Posterior Circulation Stroke/Transient Ischemic Attack and its Relationship to Site of Vertebrobasilar Stenosis

Stroke ◽

10.1161/strokeaha.112.669929 ◽

2013 ◽

Vol 44 (3) ◽

pp. 598-604 ◽

Cited By ~ 81

Author(s):

Giosue Gulli ◽

Lars Marquardt ◽

Peter M. Rothwell ◽

Hugh S. Markus

Keyword(s):

Transient Ischemic Attack ◽

Stroke Risk ◽

Posterior Circulation ◽

Posterior Circulation Stroke ◽

Ischemic Attack

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Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00325-0 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Nourhan Abdelmohsen Taha ◽

Hala El Khawas ◽

Mohamed Amir Tork ◽

Tamer M. Roushdy

Keyword(s):

Intravenous Thrombolysis ◽

Posterior Circulation ◽

University Hospitals ◽

Stroke Patients ◽

Anterior Circulation ◽

Time Points ◽

Posterior Circulation Stroke ◽

First Line Therapy ◽

Insignificant Difference ◽

Stroke Center

Abstract Background Intravenous thrombolysis (IVT) with alteplase is the first-line therapy for acute ischemic anterior and posterior circulation strokes (ACS and PCS). Knowledge about safety and efficacy of IVT in posterior circulation stroke is deficient as most of the Egyptian studies either assessed IVT outcome in comparison to conservative therapy or its outcome in anterior circulation stroke only. Therefore, our aim was to compare the relative frequency and outcome after intravenous thrombolysis in anterior versus posterior circulation stroke patients presenting to stroke centers of Ain Shams University hospitals (ASUH). Results A total of 238 anterior circulation stroke and 61 posterior circulation strokes were enrolled, onset-to-door and door-to-needle time were statistically insignificant. NIHSS showed comparable difference at all time points despite higher scores along anterior circulation stroke; 90-day modified Rankin Scale (mRS) showed significant improvement in both groups from mRS >2 to ≤2 with a better percentage along posterior circulation stroke patients. There was insignificant difference for either incidence of death or intracranial hemorrhage (ICH) between the two groups. Conclusion IVT significantly reduced NIHSS for both anterior and posterior circulation stroke along different studied time points. Meanwhile, a higher percentage of patients with posterior circulation stroke had a better mRS outcome at 90 days.

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Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis

Stroke ◽

10.1161/strokeaha.120.034040 ◽

2021 ◽

Author(s):

Mariam Ali ◽

Hendrikus J.A. van Os ◽

Nelleke van der Weerd ◽

Jan W. Schoones ◽

Martijn W. Heymans ◽

...

Keyword(s):

Systematic Review ◽

Sex Differences ◽

Acute Stroke ◽

Transient Ischemic Attack ◽

Controlled Trial ◽

Meta Analysis ◽

Neurological Symptoms ◽

Cross Sectional ◽

Ischemic Attack ◽

Meta Analyses

Background and Purpose: Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. Methods: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. Results: We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11–1.39]; I 2 =75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19–1.61]; I 2 =95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25–1.55]; I 2 =27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94–0.97]; I 2 =0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04–1.24]; I 2 =48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13–1.34]; I 2 =44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54–0.97]; I 2 =72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70–0.99]; I 2 =62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. Conclusions: There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.

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PATHOGENETIC PREDICTOR OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CARDIOEMBOLIC AND ATHEROTHROMBOTIC TRANSIENT ISCHEMIC ATTACKS

International Medical Journal ◽

10.37436/2308-5274-2019-4-15 ◽

2020 ◽

pp. 67-71

Author(s):

Vladimir Anatolevich Vodopianov

Keyword(s):

Primary Prevention ◽

Endothelial Dysfunction ◽

Transient Ischemic Attack ◽

Clinical Manifestations ◽

Neurological Symptoms ◽

Clinical Severity ◽

Transient Ischemic Attacks ◽

Vascular Disorders ◽

Endothelin 1 ◽

Ischemic Attack

To establish criteria for the severity of pathogenetic disorders in the most common forms of transient ischemic attacks, i.e. cardioembolic and atherothrombotic, a differentiated approach to the treatment and primary prevention of vascular disorders of the cerebral ischemia and dysfunction of ischemia was substantiated. To objectify endothelial dysfunction, endothelin−1 was studied with its principal antagonist − a sodium oxide vasodilator and the major pro−inflammatory cytokine TNF−α. The blood was collected from the patients 12 hours after the first neurological symptoms appeared, the purpose of which was to determine the peak values of the disturbance of biochemical parameters. The data obtained indicate that with a transient ischemic cardioembolic attack, a milder clinical manifestations is caused by less pronounced pathogenetic changes in endothelial dysfunction. At the same time, in atherothrombotic form, the neurological symptoms grow more slowly and have a more pronounced character, which is also confirmed by the study of endothelial dysfunction. Thus, the study of endothelial dysfunction severity in patients with transient ischemic attacks can justify a differentiated pathogenetic approach to treatment and improve the prevention of vascular disorders. Primary prevention in a transient ischemic attack should be directed to causes that are extravasal in nature, and at atherothrombotic treatment to atherosclerosis, mainly reduction of atherosclerotic plaques. Despite quite similar correlation of major vasoconstrictor and vasodilator disorders, a mild and moderate clinical severity due to various occlusion factors is observed. To further determine the occlusion mechanisms, it is necessary to study rheological, coagulation and dynamic parameters of patients' blood. Key words: cardioembolic transient ischemic attack, atherothrombotic transient ischemic attack, endothelial dysfunction, endothelin−1.

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Abstract TP174: Nonfocal Symptoms in Patients With Transient Ischemic Attack: The PROMISE-TIA Registry

Stroke ◽

10.1161/str.48.suppl_1.tp174 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Toshiya Ishihara ◽

Shoichiro Sato ◽

Toshiyuki Uehara ◽

Tomoyuki Ohara ◽

Mikito Hayakawa ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Stroke ◽

Ischemic Heart Disease ◽

Transient Ischemic Attack ◽

Posterior Circulation ◽

Ischemic Heart ◽

Arterial Stenosis ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Ischemic Attack

Background and purpose: Patients with transient ischemic attack (TIA) occasionally accompany nonfocal symptoms, such as decreased consciousness, confusion, amnesia, and unsteadiness. The purpose of this study was to clarify characteristics and prognosis of TIA patients having nonfocal symptoms, using data of the PROspective Multicenter registry to Identify Subsequent cardiovascular Events after TIA (PROMISE-TIA). Methods: Patients with TIA within 7 days of onset were consecutively enrolled in the Japanese nationwide registry. Factors associated with nonfocal symptoms and 1-year risk of ischemic stroke and ischemic heart disease were assessed in logistic regression and Kaplan-Meier models, respectively. Results: We studied 1348 patients with TIA (871 men, mean age of 69.4±12.4 years). Two hundred and nineteen patients (16%) had nonfocal symptoms. Patients with nonfocal symptoms were more likely to have both diffusion-weighted imaging (DWI)-positive lesions and stenosis/occlusion on vascular examination (magnetic resonance/computed tomographic angiography, or carotid ultrasound) in posterior circulation than those without (11% vs. 4%, p<0.001, 20% vs. 11%, p<0.001), but were otherwise broadly similar with respect to other baseline characteristics. Although 1-year risk of ischemic stroke was not different between the two groups (7.5% vs. 8.2%, p=0.756), the risk of ischemic heart disease was higher in patients with nonfocal symptoms (3.1% vs. 1.2%, p=0.046). Conclusions: Both ischemic changes and arterial stenosis/occlusion in posterior circulation were more frequently observed in TIA patients with nonfocal symptoms and they seem to be at high risk of ischemic heart disease. Clinical Trial Registration: URL: http://www.clinicaltraial.gov . Unique identifier: NCT01581502.

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Ischemia Modified Albumin and miR-126 Play Important Role in Diagnosis of Posterior Circulation Transient Ischemic Attack and Prediction of Secondary Cerebral Infarction

Neurology India ◽

10.4103/0028-3886.310100 ◽

2021 ◽

Vol 69 (1) ◽

pp. 75

Author(s):

Ding Lidong ◽

Xiao Zhanghong ◽

Mao Huawu ◽

Hang Xiaofang ◽

Guo Junhua ◽

...

Keyword(s):

Cerebral Infarction ◽

Transient Ischemic Attack ◽

Posterior Circulation ◽

Ischemia Modified Albumin ◽

Ischemic Attack

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Strategy and effect of repeat bypass surgery for anterior/posterior circulation in refractory moyamoya disease

Journal of Neurosurgery ◽

10.3171/2019.3.jns181979 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1889-1899

Author(s):

Haruto Uchino ◽

Daina Kashiwazaki ◽

Naoki Akioka ◽

Masaki Koh ◽

Naoya Kuwayama ◽

...

Keyword(s):

Moyamoya Disease ◽

Cerebral Artery ◽

Transient Ischemic Attack ◽

Bypass Surgery ◽

Posterior Circulation ◽

Therapeutic Effects ◽

Anterior Circulation ◽

Group A ◽

Ischemic Attack ◽

Group B

OBJECTIVEIn this study the authors aimed to describe clinical features, surgical techniques, and long-term outcomes of repeat bypass surgery required for a certain subset of patients with moyamoya disease.METHODSThe authors retrospectively reviewed a total of 22 repeat bypass surgeries for 20 patients (age range 1–69 years) performed during the last 20 years at their institutions. The patients were classified into 2 groups. Group A included 10 patients who underwent repeat bypass surgery for anterior circulation due to insufficient revascularization on the ipsilateral side. Group B included 10 patients who underwent repeat bypass surgery for posterior circulation due to the involvement of the posterior cerebral artery (PCA) after successful initial surgery for anterior circulation.RESULTSPreoperative symptoms included headache in 3 patients, transient ischemic attack in 10, cerebral infarction in 3, and intracranial hemorrhage in 4 patients. Intervals between the initial bypass surgery and repeat bypass surgery were 0.3–30 years (median 3 years). In group A, superficial temporal artery to middle cerebral artery (MCA) anastomosis and indirect bypass were performed on 7 hemispheres. Only indirect bypass was performed on 3 hemispheres because of the lack of suitable donor or recipient arteries. In group B, occipital artery (OA) to PCA anastomosis and indirect bypass were conducted on 4 hemispheres, and OA-MCA anastomosis and indirect bypass on 1 hemisphere. Only indirect bypass was conducted on 7 hemispheres because of the lack of suitable recipient arteries. All 22 repeat bypass surgeries were successfully conducted. During follow-up periods (median 4 years), none of the patients suffered repeat stroke except 1 patient who died of recurrent intracerebral hemorrhage 3 years after repeat bypass surgery for anterior circulation.CONCLUSIONSRepeat bypass surgery was feasible and effective to reduce further incidence of headache attack, transient ischemic attack, and ischemic/hemorrhagic stroke in moyamoya disease patients. Through precise radiological analysis, surgical procedures should be planned to yield maximal therapeutic effects.

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