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Transient ischemic attack patients with fluctuations are at highest risk for early stroke.
MedLine Citation:
PMID:  19390186     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The management and risk of early stroke are unclear in patients with fluctuating neurological symptoms. We aimed to evaluate the clinical course of these patients presenting within 24 h after onset of acute cerebral ischemia symptoms. METHODS: All patients with transient ischemic signs/symptoms consecutively admitted to our Emergency Stroke Unit were recruited. Patients were neurologically examined and underwent prompt CCT plus MRI imaging for visualization of early signs of ischemia. RESULTS: Among 122 patients, 84 (69%) had single symptoms, 33 (27%) showed rapidly relapsing and remitting symptoms - in 5 cases (4%) symptom duration could not reliably be assessed. 11/122 (9%) suffered a stroke during hospitalization. ABCD(2) scores did not predict early strokes: 2/11 (18.2%) were in the 'lower risk', 7/11 (63.6%) in the 'moderate risk' and only 2/11 (18.2%) in the 'high risk' group (p = 0.103). 3/11 patients (27.3%) revealed lesions in neuroimaging, but surprisingly 8/11 (72.7%, p = 0.132) did not. However, patients with fluctuations in neurological status were significantly more likely to suffer a stroke: 9/122 versus 2/122 with stable symptoms (p < 0.05). Patients with small vessel disease were common in all (53/ 122; 43.4%) and within those who suffered an early stroke (6/11; 54.5%). CONCLUSIONS: Patients with unstable transient ischemic attacks immediately after onset of clinical symptoms are at high risk for subsequent stroke - they may benefit from Stroke Unit management and potential early thrombolysis once they develop strokes.
Authors:
Anastasios Chatzikonstantinou; Olaf Willmann; Theo Jäger; K Szabo; Michael G Hennerici
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Publication Detail:
Type:  Journal Article     Date:  2009-04-24
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  27     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2009  
Date Detail:
Created Date:  2009-05-29     Completed Date:  2009-09-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  594-8     Citation Subset:  IM    
Affiliation:
Department of Neurology, Universitätsklinikum Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Blood Pressure / physiology
Cerebral Arteries / ultrasonography
Female
Humans
Ischemic Attack, Transient / complications*,  diagnosis,  physiopathology*
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Middle Aged
Prospective Studies
Recurrence
Risk Factors
Stroke / epidemiology*
Time Factors
Ultrasonography, Doppler

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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