Relevance of Transient Ischemic Attack to Early Neurological Recovery after Nonlacunar Ischemic Stroke

Abstract

Background: We hypothesized that previous transient ischemic attack (TIA) had a favorable effect on early outcome after acute nonlacunar ischemic stroke. Methods: Data of 1,753 consecutive patients with ischemic stroke collected from a prospective hospital-based stroke registry were studied. A comparison was made of the groups with and without previous TIA. Favorable outcome included spontaneous neurological recovery or grades 0–2 of the modified Rankin scale at hospital discharge. Results: Previous TIA occurred in 55 (11.5%) of 484 patients with lacunar stroke and in 166 (13.1%) of 1,269 patients with nonlacunar stroke. The percentage of nonlacunar ischemic stroke patients with favorable outcome was 21.7% in those with a history of TIA compared to 15% without TIA (p < 0.03). In the lacunar stroke group, differences were not significant. In the multivariate analysis, TIA was an independent predictor of spontaneous in-hospital recovery. Conclusions: Prior TIA was associated with a favorable outcome in nonlacunar ischemic stroke, suggesting a neuroprotective effect of TIA possibly by inducing a phenomenon of ischemic tolerance allowing better recovery from a subsequent ischemic stroke.

Hypoxic conditioning and the central nervous system: A new therapeutic opportunity for brain and spinal cord injuries?

“…41 Although TIAs are now considered as a risk factor for a subsequent stroke, 41 converging data suggest their role in preconditioning the brain to subsequent infarction. 3 TIAs occurrence may lessen brain injury and enhance recovery following a constituted stroke [42][43][44][45][46][47] and improve thrombolysis efficacy by promoting faster recanalization. 44,46 Despite some discrepancies, [48][49][50] these findings suggest an endogenous ischemic neuroprotective preconditioning effect triggered by TIAs.…”

Metabolomics predicts stroke recurrence after transient ischemic attack

“…Nonlacunar ischemic stroke patients with recent previous episodes of TIA have a favorable outcome, suggesting a neuroprotective effect of TIA by inducing a phenomenon of precondition ischemia. 38 …”

Potential Impact of Sulfonylureas in the Outcome of Type 2 Diabetic Patients With Ischemic Stroke

“…12,13 The beneficial effect of transient ischemic attack before definite cerebral infarction, probably attributable to a mechanism of ischemic tolerance, 14 is usually restricted to nonlacunar stroke. 15 The lack of efficacy in the subgroup of patients with lacunar stroke may be explained by the small size of lacunar infarcts in which maximum diameter of the lesion is Ͻ15 mm and the well know short-term good prognosis of this stroke subtype, 16 so that it is difficult to assess differences in neurological recovery in this subgroup of patients who spontaneously present a good outcome. On the other hand, the preparatory recruitment of collateral pathways is not feasible in lacunar infarction because this type of cerebral ischemia is characterized by occlusion of the terminal perforating arterioles with no possibility of mobilization of collateral pathways.…”