The relationships of reversible ischemic attacks (TIA, RIND) to completed stroke in the aged, and to atherosclerotic change at the carotid bifurcation
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One hundred nineteen patients, 68 males and 51 females, 16 with reversible ischemic attacks and 103 with non-embolic cerebral infarction, were studied to reveal the relationships of reversible ischemic attacks to completed stroke, and to atherosclerotic lesion at the carotid bifurcation. The average age of 119 patients was 70.8 years old. The diagnosis of nonembolic cerebral infarction was made by clinical signs and symptoms, CSF and CT findings. Patients with cerebral embolism were excluded from this study. Angiographic examination was performed in all cases to estimate the degree of atherosclerotic changes in the extracranial and intracranial arteries.<BR>The results were as follows :<BR>1) The history of TIA was found in 14 cases (13.6%), and preceding RIND in 7 cases (6.8%) among 103 patients with completed stroke. TIA or RIND occurred within 2 months before completed stroke in 13 (62%) out of 21 patients with preceding reversible ischemic attacks. Among 38 patients with reversible ischemic attacks, 31 cases (83.8%) showed transient or reversible symptoms in the territories of internal carotid artery (ICA), and 7 cases (16.2%) in the territories of vertebrobasilar artery. Amaurosis fugax was found in only one case.<BR>2) Atherosclerotic ulceration was found at the carotid bifurcation in 32% of 28 cases with reversible ischemic attacks in the territories of ICA, and found in 19% of all cases with completed stroke. But, this difference was not significant. TIA in the ICA territories was found in 23% of 22 cases with ulceration at the carotid bifurcation, and in 25% of 73 cases without ulceration. The history of RIND was found in 14% of cases with ulceration at the carotid bifurcation, and in 7% of cases without ulceration. There were no significant differences in the incidence of patients with TIA or RIND between the cases with and without ulceration at the carotid bifurcation.<BR>3) In stroke patients, with or without reversible ischemic attacks, about one-fourth of the cases showed more than 50% stenosis. One-half of the cases had less than 25% stenosis at the carotid bifurcation.<BR>4) The mean value of blood hematocrit was significantly higher in cases with completed stroke than in controls. Although some cases with reversible ischemic attacks showed high hematocrit value, there were no significant differences in hematocrit values between the cases with reversible ischemic attacks and controls. The average value of antithrombin III was significantly lower in cases with completed stroke and with reversible ischemic attacks than in controls.<BR>In summary, preceding TIA or RIND was found in one-fifth of old patients with cerebral infarction. Atherosclerotic change at the carotid bifurcation is not always important in the aged as a pathogenetic factor for TIA or RIND. Hypercoagulable state indicated as low value of antithrombin III may be one of the pathogenetic factors for reversible ischemic attacks and cerebral infarction.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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