Cases Of Transient Ischemic Attack Research Articles

Predictive value of stroke and transient ischemic attack discharge diagnoses in The Danish National Registry of Patients

We examined the predictive value of the discharge diagnoses of stroke and transient ischemic attack (TIA) in The National Registry of Patients (NRP) for participants in the Danish cohort study “Diet, Cancer, and Health.” We retrieved all probable incident registered cases of stroke and TIA, i.e., ICD-10: I60-69.8, or G45 ( n = 581) within the cohort from the NRP. Medical records and hospital discharge summaries were retrieved and reviewed using a standardized form. Overall, 299 of 377 cases (79.3%, 95% CI: 74.9–83.3%) of stroke recorded were confirmed. Subarachnoidal hemorrhage and intracerebral hemorrhage were confirmed in 14 of 29 cases (48.3%, 95% CI: 29.4–67.5%), and 23 of 35 cases (65.7%, 95% CI: 47.8–80.9%), respectively. By contrast, ischemic stroke and unspecified stroke were confirmed in 99 of 113 cases (87.6%, 95% CI: 80.1–93.1%) and 152 of 200 cases (76.0%, 95% CI: 69.5–81.7%), respectively. Among 134 patients with a TIA discharge diagnosis, 60.4% (95% CI: 51.6–68.8%) were confirmed. Discharge diagnoses from emergency rooms had lower overall predictive value (48.8%, 95% CI: 39.9–57.8%) than discharge diagnoses from departments of internal medicine (68.8%, 95% CI: 61.3–75.5%) and departments of neurology or neurosurgery (77.9%, 95% CI: 72.3–82.7%). We conclude that stroke and TIA diagnoses in NRP should be used with caution in epidemiological research because the low predictive value for some diagnostic subgroups may lead to serious misclassification and biased results.

Diagnosis and initial management of stroke and transient ischemic attack across UK health regions from 1992 to 1996: experience of a national primary care database.

The aim of this study was to establish the difference in burden of cerebrovascular disease across the different health regions of the United Kingdom and to determine whether the initial management of new cases of stroke and transient ischemic attack (TIA) was uniform across the United Kingdom: The General Practice Research Database (GPRD) is a national database used for epidemiological studies. This was a cohort study identifying incident cases of stroke and TIA over a 5-year study period between 1992 and 1996. The population studied was patients registered with general practitioners contributing to the GPRD across the different health regions of the United Kingdom: Outcome measures were new diagnoses of stroke and TIA, new prescriptions for antiplatelet and anticoagulant agents, and referrals made for specialist opinion. The age-adjusted annual incidence rate across all regions was 151 per 100 000 for stroke and 190 per 100 000 for TIA. There was almost a 2-fold difference in the incidence of cerebrovascular disease between the regions. The management of stroke and TIA in terms of antiplatelet prescription and of referral onward for further opinion to hospital specialists varied significantly between regions. Reported stroke and TIA incidence on the GPRD was comparable to that of other European studies. There were striking regional differences in the incidence of disease. The primary care management, both in prescription and referral rates, varied significantly between the different regions. There was a marked underuse of antiplatelet and anticoagulant agents, and referral rates for specialists' opinions were low.

What is the Cost of Admitting Patients with Transient Ischaemic Attacks to Hospital?

Financial constraints at our institution prompted us to evaluate the management of patients referred to the Acute Stroke Service because of transient ischaemic attack (TIA). We analysed age, gender, length of stay, hospital costs, discharge disposition and stroke recurrence for all cases of TIA admitted to the Acute Stroke Service between January 1, 1994, and December 31, 1996. During this time, 110 cases of TIA were admitted. All had a CT head scan, 60% had carotid Doppler ultrasound, and 30% had transthoracic echocardiography. No patients admitted with TIA died, and 92% were discharged home. The average annual cost of in-patient management of TIA was 328,000 Canadian dollars, of which 95% were accounted for by the cost of the hospital bed alone. If hospitalisation of patients with TIA could be reduced, significant cost-savings could be realised.

Treatment of Recurrent Carotid Disease

The purpose of this study was to determine whether repeat carotid endarterectomy (CEA) poses a greater risk than first-time CEA. The authors analyzed data from 893 consecutive CEA cases (1981-1993). Thirty-three patients (3.7%) had repeat CEA, and 860 (96.3%) had first-time CEA. There were statistically significantly higher incidences of hypertension (60.6% vs 44.6%), smoking (84.8% vs 55%), hypertriglyceridemia (33.3% vs 16.2%), and coronary artery disease (66.6% vs 36%) in the repeat CEA group than in the first-time CEA group. Symptomatic disease was present in 25 (75.8%) patients in the repeat group and in 576 (67%) patients in the first-time group (P>0.05). The cause of recurrence was atherosclerosis in 25 patients (76%), myointimal hyperplasia in seven patients (21.2%), and intraluminal thrombus without an underlying lesion in one patient (3%). Redo CEA with vein patch angioplasty was performed in 27 patients (82%), vein patch angioplasty alone in five patients (15%), and interposition vein graft in one patient (3%). The hospital operative mortality was 0% (n=0) in the repeat CEA group and 0.6% (n=5) in the first-time CEA group (P>0.05). The incidence of postoperative stroke was 0% (n=0) in the repeat group and 1.2% (n= 10) in the first-time group (P>0.05). There was one case (3%) of transient ischemic attack (TIA) in the repeat group, and two cases (0.2%) of TIA in the first-time group. There was no difference in the incidence of cranial nerve dysfunction between the repeat group (n=2, 6%) and the first-time group (n=41, 4.8%; P>0.05). Late follow-up data were obtained for 30 patients (mean: 61.4 months, range: 5-158 months) in the repeat CEA group and 501 patients (mean: 55.8 months, range: 17-168 months) in the first-time CEA group. The incidence of late failure (ipsilateral stroke or TIA) was 3.3% (n= 1) in the repeat group and 3.2% (n= 16) in the firsttime CEA group; P>0.05. The overall late mortality was 20% (n=6) in the repeat CEA group and 14.6% (n=73) in the primary CEA group; P>0.05. Repeat CEA can be performed safely in individuals with severe recurrent carotid stenosis, and perioperative and long-term mortality and neurologic morbidity rates are similar to those for patients undergoing first-time carotid endarterectomy.

Angiographic patterns of carotid ischemic cerebrovascular disease in Saudi Arabia

The angiographic findings in 100 Saudi patients with carotid ischemic cerebrovascular disease (CVD) (transient ischemic attacks (TIA) or strokes) were retrospectively reviewed. These patients were representative of all patients with similar disorders in the terms of sex, frequency of diabetes mellitus and ischemic heart disease. They were, however, significantly younger, smoked more, had more cervical bruits and less artrial fibrillation. Analysis of the data showed that a significant stenosis (>70%) of the carotid artery origin was found only in 12% of TIA cases, 4% in the lacunar infarction cases and 6% of the large infarction cases on the symptomatic side and only in one case of TIA in the asymptomatic side. These frequencies were significantly lower than those found in similar studies performed in western countries. This study suggests that stenoses and occlusions of extracranial carotid artery plays a smaller role in the pathogenesis of ischemic CVD in Saudis than in Caucasians. The low consumption of cigarettes among elderly and females may be one of the explanations.

Original Article: Electrophoretic Properties of Platelets from Normal, Thrombotic and ITP Patients by Doppler Electrophoretic Light Scattering Analysis.

At fixed pH and ionic environment platelet net charge depends on the composition of surface glycoproteins and phospholipids. It is believed that this composition changes, becoming more negative in the course of activation, and that certain thrombotic disorders such as transient ischemic attacks (TIA) may be associated with platelet activation. To investigate this hypothesis we measured the electrophoretic mobility (U) of normal platelets, activated normal platelets and platelets from patients with TIA and immune thrombocytopenic purpura (ITP). Normal platelets gave U = -0.91 ± 0.05 pm cmh, while normal platelets activated by ADP gave -1.25 and by collagen -1.70. TIA patients (n = 22) had mean U = -1.14 ± 0.10 and the ITP patients (n = 37) had U= -1.07 ± 0.13. The U of both patient groups differed significantly from normal controls, P < 0.001. Indeed, only 2 of the 22 TIA cases had U within 2 SD of the control value. The ITP group included 10 patients with TIA-Like symptoms; the mean U of this subgroup was identical to that of the TIA group without ITP. We conclude that U is a useful measure for research on platelet abnormalities and may even be useful as a routine clinical tool. This work was greatly facilitated by the use of an automated instrument, the DELSA 440, allowing determination of U of a given sample in as little as 5 min.

Transient ischemic attacks: Electrophysiological (conventional and topographic EEG) and radiological (CCT) evaluation

The value of electrophysiological tests: conventional electroencephalography (EEG), topographic EEG analysis as well as computerized tomography (CT) in the diagnosis and evaluation of 25 patients with manifestations of transient ischemic attacks (TIA) in the domain of the carotid system was assessed. Normal CT was the rule in TIA patients except in 8% of the cases, where nonspecific changes of brain atrophy were described. Conventional EEG, topographic EEG and spectral analysis could detect abnormalities in 48%, 80% and 64% of TIA cases respectively. None of the abnormal EEG records could be missed by topographic EEG analysis. 32% of the records were diagnosed as abnormal by topographic EEG, while conventional EEG failed to detect abnormalities. Spectral analysis of the EEG results revealed a significant decrease regarding mean high limit alpha percent power, and a significant increase regarding mean low and high limit theta percent power, as well as a significant increase of the mean high limit of the slow activities ( delta + theta) fast activities (alpha + beta) percent power ratio in the TIA group as compared to the normal control group.

Investigation of the Transient Ischemia Workload and its Incidence: Implications for Occupational Therapy Research

With limited effectiveness of medical and surgical intervention following stroke, the focus has shifted to preventing stroke and the most important warning sign of an impending stroke, the Transient Ischemic Attack (TIA) or the “mini stroke.” We found that the incidence of hospital admissions for the TIA patients in a population of slightly more than 1 million (660,598 people 25 years and older) was 1.18 per 1,000 men, or a total of 386 men, and 0.73 per 1,000 women, or a total of 258 women. The overall admission rate was 0.95 per 1,000 people 25 and older. For those hospitalized, the mean age was 67.9 years for men, and 71.3 years for women. Our epidemiological study of hospital admissions and the cases reported and managed by the general medical practitioners in the community showed the crude incidence rate of 2.89 per 1,000 people 25 years and older, while the adjustment for the world standardized population rate yielded a value of 1.26 per 1,000, or 44% of the crude rate that was actually observed. There appeared to be a marked disparity between the reported female and male cases of TIA. The research discussion focuses on two equally important thrusts: 1) development of strategies to reduce identified risk factors for stroke, and 2) establishment of a premorbid patient profile by occupational therapists that will have widespread implications for identifying changes for the potential prevention and treatment of stroke.

Transient Ischemic Attacks and the General Practitioner: Diagnosis and Management

We studied the question whether the decision of general practitioners (GPs) to refer patients with transient ischemic attacks (TIAs) to hospital departments of neurology is influenced by certain characteristics of the history or the patient. A postal questionnaire which included 10 TIA cases was sent to a random sample of 10% (n = 635) of all GPs in the Netherlands (response 59%). The cases were constructed as five pairs, in each of which one of the following characteristics was varied: nature of TIA, duration and number of attacks, age and previous history. Eighty percent of the cases were accurately diagnosed. Correct diagnoses were most often made in cases with transient hemispheral (as opposed to retinal) ischaemia, longer attacks, recurrent attacks, age below 65, and in those without a history of non-specific symptoms. Referral to the neurologist was proposed in 45% of the cases, particularly for patients with hemispheral ischaemia, shorter attacks, recurrent attacks and age below 65. Aspirin would have been prescribed in one third of the cases, also of the referred patients. We conclude that clinical trials performed in hospital departments of neurology are affected by referral selection before randomisation. If the characteristics that influence referral are also related to the efficacy of the treatments under study, the results of these trials cannot be extrapolated to general practice.

Comparison of case ascertainment by medical record linkage and cohort follow-up to determine incidence rates for transient ischemic attacks and stroke

During the period 1960–1972, the medical record linkage index method provided an estimated average annual age- and sex-adjusted rate for first transient ischemic attack (TIA) of 134 per 100,000 population for those age 50 years and older. The cohort method estimate was 237 per 100,000 population (95% confidence limits (CL), 165–310). The discrepancy was due to 18 cases of TIA noted at the time of patient visits in the cohort analysis that were not identified from the medical record analysis. The cohort analysis for all strokes at age 50 years and older was not significantly different from the medical record linkage analysis. Although the cohort follow-up method provided better case ascertainment in this study, current indexing procedures provide case ascertainment equal to that of the cohort method and at less cost. No trend was found to suggest that incidence rates for TIA were decreasing in the period 1955–1979, in contrast to stroke in Rochester, Minn.

Transient ischemic attacks in the community: occurrence and clinical characteristics. A population survey in the area of Florence, Italy.

A simple self-administered questionnaire was mailed to a population sample of 8,626 (40-65 years old) to identify transient ischemic attacks (TIAs) that occurred in the previous 12 months. This study was conducted in a well-defined, medically controlled geographic area. 75.4% of the questionnaires were returned. The procedure identified 52 TIA cases (43 definite and 9 uncertain). The 12-month period prevalence for TIAs was 6.6 per 1,000 (95% confidence limits of 4.8-8.9) among the respondents. The annual incidence rate for first TIAs was 3.1 per 1,000 (95% confidence limits of 1.9-4.7). Our results differ from those reported in hospital series or in population surveys based on clinical records, with higher incidence and prevalence rates, female preponderance and higher frequency of vertebrobasilar attacks.

The course of transient ischemic attacks.

Seventy-eight patients admitted with their first cerebrovascular episode of presumed ischemic origin were evaluated during the first 24 hours to decide whether the differential diagnosis of stroke versus transient ischemic attacks (TIAs) could be made earlier than after 24 hours, if the initial degree of neurologic deficit and the persistence of symptoms beyond a certain limit of time were taken into account. Within 1 hour, 50% of TIA cases had recovered, and 90% had recovered within 4 hours. Neurologic deficit graded by a score at onset was significantly less in TIA patients than in stroke patients. We concluded that persistence of symptoms beyond a few hours and to a lesser extent the severity of symptoms at onset or at admission give a reliable indication of the diagnosis.