Accidente isquémico transitorio de causa hemodinámica / Transient ischemic attack of hemodynamic cause

El síncope es una perdida súbita y transitoria del estado de conciencia y el tono postural con restitución completa. Según su etiología se clasifica como reflejo (neuromediado), cardíaco, neurológico (isquemia vertebrobasilar) o indeterminado. Los síncopes neurológicos se observan en contexto de accidente cerebrovascular isquémico o accidente isquémico transitorio; frecuentemente se asocian a signos deficitarios focales. Presentamos el caso de un síncope no neurológico con signos deficitarios focales en una paciente con marcada enfermedad ateromatosa. (AU)

Syncope is the abrupt and transient loss of consciousness associated with absence of postural tone, followed by complete and usually rapid spontaneous recovery. In terms of etiology, syncope is classified as reflex (neurally mediated), cardiac, neurologic (vertebrobasilar ischemia) or indeterminate. The neurologic syncope occurs in the setting of stroke or transient ischemic attack, being most frequently associated with focal neurologic symptoms. We report a case of non-neurologic syncope followed with focal neurologic symptoms in a patient with atherosclerosis disease. (AU)

Current concepts on magnetic resonance imaging (MRI) perfusion-diffusion assessment in acute ischaemic stroke: a review & an update for the clinicians.

Recently, several medical societies published joint statements about imaging recommendations for acute stroke and transient ischaemic attack patients. In following with these published guidelines, we considered it appropriate to present a brief, practical and updated review of the most relevant concepts on the MRI assessment of acute stroke. Basic principles of the clinical interpretation of diffusion, perfusion, and MRI angiography (as part of a global MRI protocol) are discussed with accompanying images for each sequence. Brief comments on incidence and differential diagnosis are also included, together with limitations of the techniques and levels of evidence. The purpose of this article is to present knowledge that can be applied in day-to-day clinical practice in specialized stroke units or emergency rooms to attend patients with acute ischaemic stroke or transient ischaemic attack according to international standards.

Diagnostic yield and therapeutic impact of transthoracic echocardiography in patients with potential cardiac sources of cerebral embolism

To explore the diagnostic yield of transthoracic echocardiography [TTE], and assess the effect of echocardiographic findings on subsequent therapy. In this retrospective study, we reviewed TTE reports and hospital records of patients diagnosed with a stroke or transient ischemic attack [TIA], screening for potential cardiac sources of embolism [CSE] from January 2006 to December 2008 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia by considering at least 15 predefined TTE criteria. The therapeutic interventions employed as a consequence of the TTE findings were sought. We analyzed 240 patients [mean patient age 58.5 +/- 14] out of 10563 TTEs. While only one patient exhibited a definite CSE on TTE, potential CSEs were found in 35 patients [14.6%], most commonly caused by left ventricular [LV] systolic dysfunction [31.4%], followed by LV regional wall motion abnormalities [25.7%]. Multivariate analysis revealed 2 independent predictors for identifying a CSE on TTE: history of coronary artery disease [odds ratio [OR] 6.2, 95% confidence interval [CI]:2.6-14.8, p=0.0001], and nationality [OR 0.16, 95% CI: 0.3-0.7, p=0.019]. The TTE findings affected therapy in only 3 patients [1.2%]. The TTE performed to exclude a CSE in patients with stroke or TIA resulted in low diagnostic yield, and had little impact on therapeutic decisions. Future refinement of clinical strategies to predict a CSE is needed to improve diagnosis, and possibly cost-effectiveness, of TTE

Investigations of patient with TIA's

Transient ischemic attacks [TIAs] result from large or small vessel disease, cardiogenic embolic events or hematological abnormalities. Every patient presenting with a TIA should have total blood count, electrocardiogram, and a brain imaging study. Noninvasive carotid testing, usually by carotid duplex ultrasonography, magnetic resonance angiography [MRA] or a conventional arteriogram may be required. In general, a TIA should be considered as a warning of impending stroke that requires rapid and efficient investigations to define and remedy the reasons for the cerebral ischemic events