Transient Ischemic Attack Patients with Fluctuations Are at Highest Risk for Early Stroke

被引:25
作者
Chatzikonstantinou, Anastasios [1 ]
Willmann, Olaf [1 ]
Jaeger, Theo [1 ]
Szabo, K. [1 ]
Hennerici, Michael G. [1 ]
机构
[1] Univ Heidelberg, Univ Klinikum Mannheim, Dept Neurol, DE-68167 Mannheim, Germany
关键词
Transient ischemic attack; Unstable fluctuation; Stroke risk factors; ABCD SCORE; TIA; THROMBOLYSIS; INDIVIDUALS; PERSPECTIVE; VALIDATION; EMERGENCY;
D O I
10.1159/000214224
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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. Copyright (C) 2009 S. Karger AG, Basel
引用
收藏
页码:594 / 598
页数:5
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