Cerebral infarction verified by cranial computed tomography and prognosis for survival following transient ischemic attack.

Abstract

Of 564 consecutive patients with transient ischemic attack, 350 (62%) had cranial computed tomography performed. Except for date of admission and smoking history, there were few differences between the patients evaluated with computed tomography and the 214 who were not Cerebral infarcts were found in 59 (17%) of the 350 tomographic evaluations. Previous clinically diagnosed stroke, older age, and male sex were all significantly associated with the occurrence of tomographically verified infarcts (/><0.05). After controlling for stroke history and other important covariates, patients with tomographically verified infarcts had significantly shorter survival times than did patients without evidence of infarction on computed tomography (p=0.035). Thus, cranial computed tomography findings appear to have important prognostic value for estimating survival following transient ischemic attack. (Stroke 1991^2:431-436)

Hemodynamic and Metabolic Changes in Transient Ischemic Attack Patients

“…28,29 These infarcts are seen not only in the region appropriate for the symptoms of TIA but also in other unrelated parts of the brain. [33][34][35][36][37][38] It has also been shown that TIA patients with ischemic brain lesions have a different prognosis from patients without lesions. 36,37,39,40 Patients with acute ischemic lesions in our study did not have significantly different metabolic ratios than patients without these acute lesions.…”

“…Because we were unable to calculate absolute metabolic concentrations, the metabolic data were expressed as ratios between the peak intensities of NAA, choline, creatine, and lactate. Total study time History of prior TIA, n (%) 9 (20) Hypertension, n (%) 16 (36) Diabetes mellitus, n (%) 4 (9) Hypercholesterolemia, n (%) 8 (18) Smoking, n (%) 17 (38) ICA stenosis (Ն99%), n (%) 6 (14) Non-hTIA, n (%) 5 (10) Acute ischemic lesions on MRI, n (%) 21 (47) White matter lesions on MRI scan, n (%) 23 (52) MR examination within 24 h after TIA, n (%) 22 (50) …”

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

“…Silent stroke was an independent marker for increased subsequent mortality and was an independent marker for increased stroke occurrence in those randomized to the medical group. Evans and colleagues 33 assessed 350 patients with TIAs and found that patients with infarct identified by CT (17%) had significantly shorter survival times. The Dutch TIA Trial Study Group 34 also reported infarct identified by CT to be an independent predictor of vascular death, stroke, or myocardial infarction for patients with TIA.…”

Environmental Tobacco Smoke and Measures of Subclinical Vascular Disease

“…However, the long-term clinical impact of such small differences in subclinical measures of atherosclerosis has been established. Such small differences in IMT of the carotid artery are powerful and independent predictors of new coronary heart disease events (7)(8)(9), and subclinical infarctions have been associated with an increase in the risk of incident stroke as large as that associated with a clinically pronounced stroke (10). As such, although these associations should be interpreted with caution, they suggest that a higher cardiovascular risk is associated with ETS exposure.…”

“…Between 10 and 40% of patients with transient ischemic attacks have SCIs (29), and in neurologic populations the prognosis for patients with SCIs is suggested to be nearly as poor as for those with clinically manifest strokes (10).…”