Etiology and clinical manifestations of transient ischemic attack
- Karen L Furie, MD, MPH
Karen L Furie, MD, MPH
- Chair and Professor of Neurology
- Alpert Medical School of Brown University
- Hakan Ay, MD
Hakan Ay, MD
- Stroke Service, Department of Neurology
- A.A. Martinos Center for Biomedical Imaging, Department of Radiology
- Massachusetts General Hospital
- Harvard Medical School
Cerebrovascular disease is the third leading cause of death in developed countries after heart disease and cancer; the overall prevalence is 794 per 100,000. It is estimated that more than 700,000 patients have a stroke each year in the United States. The loss of these patients from the work force and the extended hospitalization they require during recovery make the economic impact of the disease one of the most devastating in medicine.
Cerebrovascular disease is caused by one of several pathophysiologic processes involving the blood vessels of the brain:
●The process may be intrinsic to the vessel, as in atherosclerosis, lipohyalinosis, inflammation, amyloid deposition, arterial dissection, developmental malformation, aneurysmal dilation, or venous thrombosis.
●The process may originate remotely, as occurs when an embolus from the heart or extracranial circulation lodges in an intracranial vessel.
●The process may result from inadequate cerebral blood flow due to decreased perfusion pressure or increased blood viscosity.
- Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28.
- Brown RD Jr, Petty GW, O'Fallon WM, et al. Incidence of transient ischemic attack in Rochester, Minnesota, 1985-1989. Stroke 1998; 29:2109.
- Cancelli I, Janes F, Gigli GL, et al. Incidence of transient ischemic attack and early stroke risk: validation of the ABCD2 score in an Italian population-based study. Stroke 2011; 42:2751.
- Kleindorfer D, Panagos P, Pancioli A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 2005; 36:720.
- Kimura K, Minematsu K, Yasaka M, et al. The duration of symptoms in transient ischemic attack. Neurology 1999; 52:976.
- Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982; 32:871.
- Kappelle LJ, van Latum JC, Koudstaal PJ, van Gijn J. Transient ischaemic attacks and small-vessel disease. Dutch TIA Study Group. Lancet 1991; 337:339.
- Donnan GA, O'Malley HM, Quang L, et al. The capsular warning syndrome: pathogenesis and clinical features. Neurology 1993; 43:957.
- Hervé D, Gautier-Bertrand M, Labreuche J, et al. Predictive values of lacunar transient ischemic attacks. Stroke 2004; 35:1430.
- North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325:445.
- Kistler JP, Buonanno FS, Gress DR. Carotid endarterectomy--specific therapy based on pathophysiology. N Engl J Med 1991; 325:505.
- MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group. Lancet 1991; 337:1235.
- Mayberg MR, Wilson SE, Yatsu F, et al. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group. JAMA 1991; 266:3289.
- Roederer GO, Langlois YE, Jager KA, et al. The natural history of carotid arterial disease in asymptomatic patients with cervical bruits. Stroke 1984; 15:605.
- Chambers BR, Norris JW. Outcome in patients with asymptomatic neck bruits. N Engl J Med 1986; 315:860.
- Meissner I, Wiebers DO, Whisnant JP, O'Fallon WM. The natural history of asymptomatic carotid artery occlusive lesions. JAMA 1987; 258:2704.
- Suwanwela N, Can U, Furie KL, et al. Carotid Doppler ultrasound criteria for internal carotid artery stenosis based on residual lumen diameter calculated from en bloc carotid endarterectomy specimens. Stroke 1996; 27:1965.
- Can U, Furie KL, Suwanwela N, et al. Transcranial Doppler ultrasound criteria for hemodynamically significant internal carotid artery stenosis based on residual lumen diameter calculated from en bloc endarterectomy specimens. Stroke 1997; 28:1966.
- PATHOPHYSIOLOGIC MECHANISMS
- Large artery low flow TIA
- Embolic TIA
- Lacunar TIA
- CLINICAL MANIFESTATIONS
- Low-flow TIA
- Embolic TIA
- Lacunar or small vessel TIA
- IMPORTANT PATHOLOGIC PROCESSES
- Internal carotid artery TIA
- Intracranial atherothrombotic disease
- Arterial, aortic, or cardiac sources of emboli
- Dissection lesions
- INFORMATION FOR PATIENTS