No abstract

The purpose of this study was to determine frequency and the characteristics of diffusion-weighted imaging (DWI) abnormalities in patients with transient ischaemic attack (TIA). We analysed data of 98 consecutive patients (mean age: 60.6+/-15.4 years, 56 men) admitted between January 2003 and April 2004 for TIA. Age, gender, symptom type and duration, delay from onset to magnetic resonance imaging (MRI), probable or possible TIA and cause of TIA were compared in patients with (DWI+) and without (DWI-) lesions on DWI. Volume and apparent diffusion coefficient (ADC) values of DWI lesions were computed. DWI revealed ischaemic lesions in 34 patients (34.7%). Lesions were small (mean volume: 1.9 cm(3)+/-3.3), and ADC was moderately decreased (mean ADC ratio: 79.5%). The diagnosis of TIA was considered as probable in all DWI+ patients. A multiple logistic regression model demonstrated that TIA duration greater than or equal to 60 min (OR, 7.6; 95% CI, 2.3-25.7), aphasia (OR, 9.2; 95% CI, 2.7-31.4) and motor deficit (OR, 5.1; 95% CI, 1.5-17.8) were independent predictors of DWI lesions. Prolonged TIA duration, aphasia and motor deficits are associated with DWI lesions. More than half of TIA patients with symptoms lasting more than 60 min have DWI lesions.

The prognosis of cervical artery dissection (CAD) patients mainly depends on the severity of the initial stroke and the risk of subsequent stroke. The overall functional prognosis of patients with stroke due to CAD does not differ from that of young patients with stroke due to other causes. The annual risk of recurrent stroke ranges from 0.3 to 3.4%. Early recurrences are often in the territory of the CAD when arterial lesions had not completely recovered. Conversely, long-term recurrent ischemic events seem to take place in all territories and can be due to various mechanisms. The prognosis of CAD patients also depends on the arterial outcome. Stenotic lesions resolve within a few months, most often without visible sequel on angiogram, in about 70% of patients. Recanalization of occluded vessels is less frequent but in more recent studies, which used imaging to confirm the presence of a mural hematoma, recanalization occurred in up to 90% of cases. Carotid aneurysms persist in about two third of cases while vertebral aneurysms seem to frequently resolve. Complications related to persistent aneurysm seem to be exceptional. The overall risk of CAD recurrence is low, ranging from 0.3 to 1.4% but seems to be higher within the first month and some recurrences are asymptomatic. Patients with connective tissue disease or familial history of CAD have an increased risk of CAD recurrence, but other risk factors remain unknown.

Background: Management of vascular risk factors is not optimal in stroke patients. We assessed the control of hypertension, smoking and stopping of oral contraceptive in 581 consecutive young cryptogenic ischemic stroke patients followed in the PFO-ASA study and we identified factors associated with inadequate management. Methods: At each follow-up visit, blood pressure (BP), smoking and use of oral contraceptive were recorded. Data were analyzed at 6 months, 1 and 2 years. Hypertension was defined as systolic BP ≧140 or diastolic BP ≧90 mm Hg, recorded in at least two follow-up visits. Current smoking was defined as more than one cigarette per day reported during at least one follow-up visit. Results: During follow-up, 36% of patients were hypertensive and 30% were smokers. Among the 90 hypertensive patients at baseline, 60–68% remained with high BP and among the 278 patients who were current smokers at baseline, 54–58% still smoked during follow-up. Age (OR = 1.05, 95% CI 1.02–1.08), male sex (OR = 1.42, 95% CI 0.93–2.18), body mass index ≧27 (OR = 2, 95% CI 1.27–3.17) and known hypertension (OR = 3.08, 95% CI 1.80–5.28) were significantly associated with hypertension during follow-up. Tobacco consumption at baseline (OR = 35.2, 95% CI, 19.3–64.2), alcohol consumption at baseline (OR = 2.7, 95% CI 1.4–5.2) and Rankin ≤2 (OR = 2.6, 95% CI 1.4–4.9) were independently associated with persistent smoking. Among the 114 women who were using combined estrogen-progesterone pills at baseline, 96.5% stopped. Conclusions: Major risk factors for stroke are poorly controlled after stroke, even in the context of a prospective clinical study in young adults.

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