Classification of etiologic subtypes for transient ischemic attacks: Clinical significance of lacunar transient ischemic attack

AbstractTransient ischemic attacks (TIA) are a common presentation to the emergency department (ED) and are associated with an estimated 9% risk of stroke within 90 days.1 We report the case of a 72-year-old female who presented with orthostatic symptoms of facial weakness and dysarthria; that is, the patient’s symptoms were present when she was standing and resolved when supine. Neurological deficits present only when standing should alert the clinician to the importance of advanced neuroimaging to evaluate for acute arterial occlusion.

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Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack

Stroke ◽

10.1161/strokeaha.111.000787 ◽

2013 ◽

Vol 44 (6) ◽

pp. 1635-1640 ◽

Cited By ~ 14

Author(s):

Junpei Kobayashi ◽

Toshiyuki Uehara ◽

Kazunori Toyoda ◽

Kaoru Endo ◽

Tomoyuki Ohara ◽

...

Keyword(s):

Clinical Significance ◽

Transient Ischemic Attack ◽

Inversion Recovery ◽

Fluid Attenuated Inversion Recovery ◽

Ischemic Attack

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Faculty Opinions recommendation of Four-year follow-up of transient ischemic attacks, strokes, and mimics: a retrospective transient ischemic attack clinic cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725410994.793538003 ◽

2017 ◽

Author(s):

Jose Biller ◽

Michael Schneck

Keyword(s):

Cohort Study ◽

Transient Ischemic Attack ◽

Transient Ischemic Attacks ◽

Ischemic Attack

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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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Transient ischemic attacks: predictability of future ischemic stroke or transient ischemic attack events

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s54810 ◽

2014 ◽

pp. 27 ◽

Cited By ~ 1

Author(s):

Manoj Mittal ◽

Ann Farrell ◽

Harsh Gupta

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Transient Ischemic Attacks ◽

Ischemic Attack

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The prevalence and clinical significance of ischemic lesions on diffusion-weighted image in patients with transient ischemic attack

Nosotchu ◽

10.3995/jstroke.35.328 ◽

2013 ◽

Vol 35 (5) ◽

pp. 328-336 ◽

Cited By ~ 1

Author(s):

Keizo Yasui ◽

Noriyoshi Nakai ◽

Amane Araki ◽

Kazuya Kawabata ◽

Shinichiro Yamada ◽

...

Keyword(s):

Clinical Significance ◽

Transient Ischemic Attack ◽

Diffusion Weighted Image ◽

Weighted Image ◽

Diffusion Weighted ◽

Ischemic Attack

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Ticagrelor in unstable carotid stenosis - a case report

Medicinski pregled ◽

10.2298/mpns2104127p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 123-126

Author(s):

Aleksandra Ilic ◽

Vladimir Galic ◽

Dmitar Vlahovic ◽

Tamara Rabi-Zikic ◽

Mirjana Jovicevic ◽

...

Keyword(s):

Case Report ◽

Platelet Aggregation ◽

Carotid Stenosis ◽

Antiplatelet Therapy ◽

Transient Ischemic Attack ◽

Dual Antiplatelet Therapy ◽

Transient Ischemic Attacks ◽

Suitable Alternative ◽

Ischemic Attack ◽

Aggregation Analysis

Introduction. Ticagrelor is an oral, reversible, direct-acting inhibitor of adenosine diphosphate receptor P2Y12, which has a faster onset of action and stronger inhibition of platelet aggregation than clopidogrel. Case Report. This case report describes a 54-year-old male patient with repeated, transient ischemic attacks due to ipsilateral, significant carotid stenosis registered by carotid duplex ultrasound. In addition to aspirin, clopidogrel and rosuvastatin were added to the therapy. Despite optimal treatment, the patient was continuously unstable with frequent but transient neurological symptoms. A magnetic resonance imaging of the brain showed acute, cortical-subcortical ischemic lesions in the left frontal and parietal lobes, while the computed tomography angiography of the endocranium showed progression of findings and occlusion of the left common carotid artery. Subsequently, laboratory platelet aggregation analysis confirmed aspirin resistance and poor response to clopidogrel. Episodes of transient ischemic attacks were stabilized after the exclusion of dual antiplatelet therapy and introduction of ticagrelor. After that, the patient?s symptoms did not recur and he remained stable. Conclusion. The incidence of resistance to antiplatelet therapy in patients with stroke or transient ischemic attack varies greatly and ranges from 3% to 85% for aspirin, and 28% to 44% for clopidogrel. Our case showed that platelet aggregation analysis is reasonable if patients with transient ischemic attack or minor acute ischemic stroke are neurologically unstable, despite optimal medical treatment and when other therapeutic options, such as carotid revascularization, are not indicated. In such situations, ticagrelor may be a suitable alternative to dual antiplatelet therapy.

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Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients

Blood ◽

10.1182/blood-2020-133476 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 3-3

Author(s):

Omar Raslan ◽

Christopher Tran ◽

Fatimah Al-Ani ◽

Luciano Sposato ◽

Alejandro Lazo-Langner

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Patent Foramen Ovale ◽

Research Funding ◽

Transient Ischemic Attacks ◽

Foramen Ovale ◽

Stroke Patients ◽

Thrombophilia Screening ◽

Ischemic Attack

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits. Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale. Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale. Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits. Disclosures Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.

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The Role of Substance P in the Cerebral Ischemia

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463200301600110 ◽

2003 ◽

Vol 16 (1) ◽

pp. 67-72 ◽

Cited By ~ 30

Author(s):

G. Bruno ◽

F. Tega ◽

A. Bruno ◽

U. Graf ◽

F. Corelli ◽

...

Keyword(s):

Brain Injury ◽

Cerebral Ischemia ◽

Substance P ◽

Transient Ischemic Attack ◽

Serum Levels ◽

Significant Difference ◽

Cerebral Ischemic ◽

Ischemic Attack

Tackykinins are involved in the inflammatory process of a large number of diseases. The role of the tachykinins in ischemic brain injury was evaluated by the serum levels of Substance P (SP), one of the most known tachykinins and detected by a competitive enzyme immunoassay. The study was performed in 15 human females and 3 human males with typical manifestation of complete stroke (12 cases) or transient ischemic attack (6 cases). The mean SP level in the serum of patients with transient ischemic attack (0.53±0.25 ng/ml) and of patients with complete stroke (0.31±0.14 ng/ml), showed significantly higher values than in controls (0.10±0.02 ng/ml). Moreover, in transient ischemic attack, the SP values were significantly higher than in cerebral complete stroke. But SP levels, based on the timings of classification of patients (i.e. before 12 hours: 0.34±0.15 ng/ml vs. 12 to 24 hours: 0.26±0.11 ng/ml) with brain injury, did not show any significant difference. Both values anyway were significantly higher than in controls. Our original results demonstrate the SP increase during cerebral ischemia. Further studies are necessary to verify if SP has an effective physiopathological role in the neurological ischemic damage, or if it is only a concomitant phenomenon. Our data, if confirmed, will be particularly important, not only to improve the knowledge of cerebral ischemic injury, but also for diagnosis and therapeutic approaches.

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