Audit of Transient Ischaemic Attack (TIA) inpatient management: a retrospective assessment

@#The aim of this retrospective study was to audit the management of transient ischaemic attack (TIA) patients admitted in 2012 compared to a previous audit (2009 to mid-2010). Data were obtained by reviewing the electronic clinical records of patients. Data on patient demographics, patient assessment and management according to TIA guidelines were collected. A total of 61 patients were admitted to hospital with primary diagnosis of TIA. One in four patients had an alternative diagnosis. TIA severity (ABCD2 score) was not calculated in 13% of the patients. Most patients had computed tomography (CT) brain imaging performed. Antiplatelet therapy was not adjusted in 10% of patients. Carotid doppler ultrasound was not considered in 20% of the patients. Most of the carotid dopplers were done within one week. Only 6.6% of the patients were referred for carotid endarterectomy. Blood pressure medications were not optimised in 57.4% of the patients. Only 27.9% were prescribed statin therapy. Not all patients had documented ECG findings or discussion regarding anticoagulation. There was a 32.8% 3-month readmission rate. In 2012 several aspects of TIA guideline management were not done appropriately compared to the previous audit. The areas of improvement identified in this assessment include optimising antiplatelet therapy and blood pressure management, as well as timely carotid ultrasound for anterior circulation TIA. Further education and reiteration of guideline-based TIA management is recommended. A follow-up audit of the service is warranted

Epidemiológica del ataque cerebro vascular en un hospital universitario / Epidemiological of cerebrovascular attack in a university hospital / Epidemiologia do ataque cerebrovascular em hospital universitário

Resumen: Introducción: El ataque cerebro vascular es una enfermedad prevalente en nuestro medio con elevada morbimortalidad. El Hospital Pasteur es un centro de tercer nivel, que asiste un elevado número de pacientes con esta patología. Conocer los datos epidemiológicos de esta afección permitirá desarrollar medidas de promoción de salud y prevención primaria. Identificar la forma de presentación clínica y los algoritmos de estudio, permitirán un adecuado diagnóstico, tratamiento precoz y desarrollo de medidas de prevención secundaria. Objetivos: Conocer las características sociodemográficas de la población con diagnóstico de ataque cerebro vascular o accidente isquémico transitorio asistidas en las salas de medicina del Hospital Pasteur, los factores de riesgo asociados, las formas de presentación clínica y precisar si se cumplió con el algoritmo diagnóstico propuesto. Métodos y procedimiento: Estudio descriptivo observacional y transversal realizado en el Hospital Pasteur. La población de estudio fueron pacientes adultos ingresados en sala de medicina con diagnóstico de ataque cerebro vascular o accidente isquémico transitorio que presentaron el evento durante su internación, en el periodo comprendido entre Julio y Setiembre de 2018. Resultados y discusión: Se recabaron datos de 29 pacientes, 20 de sexo femenino. La media de edad fue de 70.34 años. La naturaleza isquémica fue la más prevalente. Los factores de riesgo cardiovascular más frecuentes fueron HTA, sedentarismo, dislipemia y tabaquismo. La principal forma de presentación fue síndrome piramidal. Se cumplió con el algoritmo diagnostico en todos los pacientes. Conclusión: Conocer los factores de riesgo, naturaleza y forma de presentación clínica permite elaborar estrategias de prevención primaria y secundaria para el abordaje integral de estos pacientes, intentando así reducir la incidencia y secuelas de esta enfermedad.

Abstract: Introduction: Acute ischemic stroke is a prevalent condition in our working environment, with high morbility and mortality. Hospital Pasteur is a tertiary level institution, which assists an elevated number of patients with acute ischemic stroke. Getting to know its epidemiologic characteristics will enable the development of health promotion and primary prevention measures. Identifying its clinical presentation form and applying validated study algorithms will allow for a proper diagnosis, early treatment and development of secondary prevention measures. Objectives: To study the sociodemographic characteristics of patients diagnosed with acute ischemic stroke or transient ischemic attack assisted in Hospital Pasteur´s Internal Medicine wards, their associated risk factors, clinical presentation and to determine whether the proposed study algorithm was followed. Methodology and procedure: This is a descriptive, observational and transversal study which took place at Hospital Pasteur. The population consisted of adult patients admitted to Internal Medicine wards with the diagnosis of acute ischemic stroke, transient ischemic attack or who presented the event during their stay, between the months of July and September 2018. Results and discussion: The data of 29 patientes was obtained; 20 were female. The mean age was 70.34 years. Ischemic nature was the most prevalent. The most frequent risk factors were arterial hypertension, sedentary lifestyle, dyslipidemia and smoking. Pyramidal syndrome was the most common clinical presentation. A study algorithm was followed in all patients. Conclusion: Getting to know the risk factors, nature and clinical presentation form of AIS and TIA allows for the creation of primary and secondary prevention strategies for the comprehensive approach of these patients, therefore intending to reduce this disease´s incidence and its terrible consequences.

Resumo: Introdução: O ataque cerebrovascular é uma doença prevalente em nosso meio, com alta morbimortalidade. O Hospital Pasteur é um centro de terceiro nível, que auxilia um grande número de pacientes com essa patologia. Conhecer os dados epidemiológicos dessa condição permitirá o desenvolvimento de ações de promoção da saúde e prevenção primária. Identificar a forma de apresentação clínica e os algoritmos do estudo permitirá um diagnóstico adequado, tratamento precoce e desenvolvimento de medidas de prevenção secundária. Objetivos: Conhecer as características sociodemográficas da população com diagnóstico de ataque cerebrovascular ou ataque isquêmico transitório assistido nas salas médicas do Hospital Pasteur, os fatores de risco associados, as formas de apresentação clínica e determinar se o algoritmo de diagnóstico proposto foi atendido. Métodos e procedimentos: Estudo observacional e transversal descritivo realizado no Hospital Pasteur. A população do estudo foi de pacientes adultos admitidos na enfermaria com diagnóstico de ataque cerebrovascular, ataque isquêmico transitório que apresentaram o evento durante sua internação, no período entre julho e setembro de 2018. Resultados e discussão: Os dados foram coletados de 29 pacientes, sendo 20 do sexo feminino. A idade média foi de 70,34 anos, sendo a natureza isquêmica a mais prevalente. Os fatores de risco cardiovascular mais frequentes foram hipertensão arterial, sedentarismo, dislipidemia e tabagismo. A principal forma de apresentação foi a síndrome piramidal. O algoritmo de diagnóstico foi preenchido em todos os pacientes. Conclusão: Conhecer os fatores de risco, natureza e forma de apresentação clínica permite desenvolver estratégias de prevenção primária e secundária para abordagem abrangente desses pacientes, buscando reduzir a incidência e sequelas da doença.

Rare mimicker of transient ischaemic attacks: the syndrome of transient headache and neurological deficits with cerebrospinal luid lymphocytosis

The syndrome of transient headache and neurologic deficits associated with cerebrospinal fluid lymphocytosis (HaNDL) is a benign and self limiting disorder characterized by 1 or more episodes of severe headache and transient neurologic deficits with lymphocytic pleocytosis in the cerebrospinal fluid. We report a case of a 30-year-old male who presented with four episodes of headache followed by hemi paresis and hemisensory loss in a week the patient was completely asymptomatic in between each episode of headache with neurological deficits. Persistent serial imaging to visualize the brain were normal with evidence of cerebrospinal fluid lymphocytosis, which lead to the diagnosis of HaNDL. We need to advocate a high degree of suspicion for HaNDL in the background of strong clinical history and findings, when imaging is normal.

A Study of Risk Factors of Cerebrovascular Accident at a Tertiary Care Centre in Western UP

A stroke or CVA is defined by the abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Important modifiable risk factors include diabetes, hypertension, smoking, alcohol intake, sedentary life style, dyslipidemia, heart disease and OCP intake in females and non-modifiable risk factors include old age, gender predisposition and family history. The aim of study is to determine the types of stroke and presenting clinical features and modifiable and non-modifiable risk factors associated with development of stroke. Methods: The present study is a prospective observational study conducted in Teerthanker Mahaveer Medical College over a period of one year i.e January 2017 to January 2018.Total 110 cases presenting with stroke were included in the study. Results: The study shows that ischemic stroke is commoner than hemorrhagic stroke.The risk of stroke increases with age and common in males.Diabetes mellitus was seen in 29.1% cases presenting with stroke, 39.1% cases had hypertension.43.6% and 22.7 were smokers and alcoholic respectively. Dyslipidemia was present in 37.3% cases.15.4% cases had history of heart disease.17.2% cases had previous history of stroke. Conclusion: The modifiable risk factors pose a huge burden by increasing the morbidity and mortality due to stroke. Proper control of these risk factors can reduce the burden of disease.

The Study of Serum Uric Acid Levels in Ischemic Stroke Patients

Introduction: Stroke is defined by (WHO) World HealthOrganization as ‘a clinical syndrome consisting of rapidlydeveloping clinical signs of focal (or global in case of coma)disturbance of cerebral function lasting more than 24 hour orleading to death with no apparent cause other than a vascularorigin.’ There are few studies conducted in Indian scenario,which shows the role of serum uric acid in cases of acuteischaemic stroke. So the present study aimed at evaluatingrole of uric acid in assessing severity of acute ischemic stroke.Material and methods: It was an Analytical, Noninterventional Prospective study conducted among 100 casesof acute ischaemic stroke admitted in medicine ward and ICUat Krishna hospital, Karad over the period of 18 months, whofulfilled inclusion criteria were included in our study.Results: In the present study, serum uric acid levels and itsdistribution was carried out. Mean levels of Serum Uric acidwas 4.92 ± 1.89 mg/dl. Maximum value being 8.4 mg/dl andminimum value was 1.2 mg/dl.Conclusion: The severity of acute ischaemic stroke wasproved to be directly proportional to the mean serum uric acidlevels in the present study.

Effects of " acupuncture on cerebral blood flow in patients with high risk of cerebral ischemic stroke based on ASL and PWI technique / 中国针灸

OBJECTIVE@#To observe the effects of "" acupuncture on cerebral blood flow in high-risk patients of cerebral ischemic stroke based on arterial spin labeling (ASL) and perfusion-weighted imaging (PWI), and to evaluate the clinical efficacy.@*METHODS@#A total of 180 patients with transient ischemic attacks (TIA) / minor ischemic stroke (MIS) were randomly divided into an acupuncture A group, an acupuncture B group and a medication group, 60 cases in each group. The patients in the acupuncture A group were treated with "" acupuncture at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Mingmen (GV 4), Yaoyangguan (GV 3) and Jingjiaji (EX-B 2), once a day; the patients in the acupuncture B group were treated with identical acupoints but was given once every other day; the patients in the medication group were treated with oral administration of nimodipine tablets, 30 mg, three times daily. All the three groups were treated for four weeks. ASL and PWI, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT) and relative time to peak (rTTP), were conducted before and after treatment; the changes of the test indexes were compared before and after treatment. The clinical efficacy of the three groups was compared.@*RESULTS@#Compared before treatment, the numbers of ASL normal perfusion in the 3 groups were significantly increased after treatment (all 0.05). Compared before treatment, rCBV and rCBF in the 3 groups were significantly increased after treatment (all 0.05). The total effective rate was 88.3% (53/60) in the acupuncture A group, 73.3% (44/60) in the acupuncture B group and 90.0% (54/60) in the medication group; the total effective rate in the acupuncture A group was superior to that in the acupuncture B group (0.05).@*CONCLUSION@#"" acupuncture could effectively improve the hypoperfusion of cerebral blood flow in patients with high risk of cerebral ischemic stroke, reduce the incidence of severe CIS; acupuncture for once a day is better than once every other day.

Outpatient management of transient ischaemic attack

Stroke is a significant cause of death and disability in Singapore; in 2014, it was the fourth most common cause of death. Transient ischaemic attack (TIA) is defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without evidence of acute infarction. The diagnosis of TIA/acute stroke needs to be considered in all patients who present with sudden focal neurological dysfunction. Prompt referral for assessment, neuroimaging and intervention provides the best chance for neurological recovery and/or minimising further neurological damage. Primary care physicians have a crucial role in TIA/stroke prevention and management. This includes referring patients with suspected acute TIA/stroke to hospitals with stroke treatment facilities immediately; managing the modifiable risk factors of cerebral ischaemia; continuing prescription of antiplatelet agents and/or anticoagulation where indicated; and teaching patients to recognise and respond to suspected cerebral ischaemia using the FAST (face, arm, speech, time) acronym.

Dual Antiplatelet Therapy after Noncardioembolic Ischemic Stroke or Transient Ischemic Attack: Pros and Cons

Dual antiplatelet therapy simultaneously blocks different platelet activation pathways and might thus be more potent at inhibiting platelet activation and more effective at reducing major ischemic vascular events compared to antiplatelet monotherapy. Aspirin plus clopidogrel dual therapy is now the standard therapy for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. However, dual antiplatelet therapy carries an increased risk of bleeding. Patients with ischemic stroke or transient ischemic attack (TIA) are generally older and likely to have a fragile cerebrovascular bed, which further increases the risk of systemic major bleeding events and intracranial hemorrhage. Clinical trials and meta-analyses suggest that in comparison to antiplatelet monotherapy, dual antiplatelet therapy initiated early after noncardioembolic ischemic stroke or TIA further reduces the rate of recurrent stroke and major vascular events without significantly increasing the rate of major bleeding events. In contrast, studies of long-term therapy in patients with noncardioembolic ischemic stroke or TIA have yielded inconsistent data regarding the benefit of dual antiplatelet therapy over monotherapy. However, the harm associated with major bleeding events, including intracranial hemorrhage, which is generally more disabling and more fatal than ischemic stroke, is likely to increase with dual antiplatelet therapy. Physicians should carefully assess the benefits and risks of dual antiplatelet therapy versus antiplatelet monotherapy when managing patients with ischemic stroke or TIA.

Effect of acupuncture and herbs on risk factors and prognosis of patients with transient ischemic / 国际中医中药杂志

Objective To observe the effect of acupuncture and herbs on risk factors and prognosis of transient ischemic attack (TIA).Methods 120 patients received treatment from March to May 2011 in Gaomi People's Hospital and the Hospital of Gaomi were randomly divided into three groups,with 40 cases in each.Acupuncture and Chinese medicine group was treated with needling Neiguan and administered with modified Tianmagouteng decoction,3 times/d; Chinese medicine group was treated with modified Tianmagouteng diction exclusively,3 times/d; Western medicine group was treated with Aspirin,0.1 g,1 times/d.The three groups were treated for 30 d of two therapeutic courses.TCM syndrome score,blood pressure,blood lipids,blood rheology,blood sugar changes in the three groups of patients were observed before and after the treatment.And follow-up of elapse rate and the incidence of stroke in a year were observed.Results After treatment,① in the acupuncture and Chinese medicine group: the total cholesterol was (5.21 ± 0.97)mmol/L,whole blood viscosity was [(4.26±0.66) 200 mPa · s,(5.69±0.15) 30 mPa · s,(9.72±2.33) mPa · s],fibrinogen was (2.12± 0.46)g/L,systolic blood pressure was (124.13±9.96) mm Hg,diastolic blood pressure was (79.23±7.50) mm Hg,blood glucose was (5.59 ±0.78) mmol/L; in the Chinese medicine group,the total cholesterol was (5.43± 1.04) mmol/L,whole blood viscosity was [(4.25±0.25) 200 mPa · s,(5.46±0.55) 30 mPa · s,(9.81± 2.01) 5 mPa · s],fibrinogenwas (2.32±0.33) g/L,systolic blood pressure was (129.78±14.25) mm Hg,diastolic blood pressure was (79.54± 7.65) mm Hg,blood glucose was (5.60± 0.75) mmol/L; in the western medicine group,the total cholesterol was (5.52± 1.16) mmol/ L,full blood viscosity was [(4.12±0.54) 200 mPa · s,(5.45± 0.65) 30 mPa · s,(9.09 ± 1.11) mPa · s],fibrinogen was (2.41 ± 0.44) g/L,systolic blood pressure was (129.83 ± 14.91) mm Hg,diastolic blood pressure was (80.72±7.47) mm Hg,blood glucose was (5.75 ± 0.61) mmol/L.all these results were improved significantly than those before the treatment in the same group (P＜0.05),and the acupuncture and Chinese medicine group improved better than the other two groups (P＜0.05).② In 1-year follow-up,TIA recurrence rate of stroke in the acupuncture group were lower than the other two groups.Conclusion Acupuncture and Chinese medicine treatment were not only be able to improve the clinical symptoms of patients with TIA and blood pressure,blood lipids,blood theology,blood sugar and other risk factors for TIA patients significantly,but also can effectively reduced the relapse rate and the incidence of stroke.

Juxtacortical Spots on Fluid-Attenuated Inversion Recovery Images in Cryptogenic Transient Ischemic Attack

BACKGROUND AND PURPOSE: Juxtacortical spots are detected frequently on fluid-attenuated inversion recovery (FLAIR) images, but have not been extensively researched in patients with transient ischemic attack (TIA). We hypothesized that juxtacortical spots on FLAIR images are partly associated with right-to-left shunt (RLS) in TIA without clear etiology. The possibility of an association between the presence of RLS and juxtacortical spots on FLAIR images in patients with TIA without clear etiology was investigated, and the imaging findings of patients with and without RLS were compared. METHODS: This was a retrospective study of TIA patients who visited our tertiary stroke center consecutively within 72 hours of TIA onset. Cryptogenic TIA was defined as no clear etiology despite a routine diagnostic workup. The presence of RLS was examined by transcranial Doppler with an agitated saline test or transesophageal echocardiography. Juxtacortical spots were defined as small and round hyperintensities in the juxtacortex on FLAIR images, excluding white-matter hyperintensities. RESULTS: Of the 132 patients with cryptogenic TIA examined for this study, 70 (53.0%) had RLS. Juxtacortical spots on FLAIR images were detected more frequently in patients with RLS than in those without. The independent factors for the presence of juxtacortical spots were RLS [odds ratio (OR)=3.802, 95% confidence interval (95% CI)=1.74-8.2; p=0.001] and age (OR=1.058, 95% CI=1.01-1.10; p=0.004) by multivariate analysis. The number of juxtacortical spots was significantly higher among patients with a moderate-to-large RLS than in those with a small or no RLS. CONCLUSIONS: The findings of the present study demonstrate a significant association between the presence of RLS and the occurrence of juxtacortical spots on FLAIR images in patients with cryptogenic TIA.

Establishment of Reference Range of Serum Ferritin by Turbidimetric Immunoassay in Korean First Time Blood Donors / 대한수혈학회지

BACKGROUND: Regular blood donation can lead to iron deficiency. Serum ferritin is sensitive indicator of body iron depletion. The aim of this study is to evaluate serum ferritin reagents using the turbidimetric immunoassay (TIA) and to establish a reference range in first time blood donors in Korea. METHODS: The study was prospectively conducted, between Feb. 2011 and Apr. 2011, on 120 male and 120 female blood donors at five blood centers. Serum ferritin was determined by TIA using two brands of reagents (Beckman Coulter Inc., USA; HBi, South Korea) and two automated chemistry analyzers (AU640, Beckman Coulter Inc.; Hitachi7180, Hitachi High-Technologies Corp., Japan). Precision, linearity, limit of detection, analytical measurement range and correlation with chemiluminescent immunoassay (CLIA) were evaluated. A reference range for serum ferritin in first time donors was established. RESULTS: The coefficients of variation of precision were less than 4%. Linearity was observed up to 312.7~450 microg/L depending on which reagent used. Both reagents had good correlation with CLIA results. Serum ferritin levels for first time donors showed left skewed distribution. The reference ranges for males and females were 34.1~385.9 microg/L and 6.8~121 microg/L using Beckman Coulter (AU) reagent, and 18.7~271.3 microg/L and 4~83.7 microg/L using HBi (AU) reagent, and 15.2~274.7 microg/L and 6~84 microg/L using HBi (Hitachi) reagent. CONCLUSION: A reference range for serum ferritin in first time donors in Korea was established using automated chemistry analyzers with inexpensive TIA reagents.

The study on dynamic CT perfusion imaging and in recurrence of TIA / 中国神经精神疾病杂志

Objective Evaluation of cerebral blood flow in patients with transient ischemic attack (TIA) using cerebral CT perfusion imaging.Methods CT perfusion scan was performed on a consecutive series of 20 patients with clinical definite TIA.Following their initial CT scan at acute stage of TIA, patients underwent two repeat CT perfusion scanning of region of interest at acute stage and one month after symptom remission.Results Mild to moderate decrease in regional cerebral blood flow (rCBF) and unchanged or mildly decrease in regional cerebral blood volume (rCBV) were observed at acute stage in the majority cases.Normal cerebral perfusion was found in 12 cases and mild to moderate decrease of rCBF in 8 cases one month after TIA.During the one-year follow-up period, all of 12 cases with normal cerebral perfusion did not have recurrence while among 8 cases with mild to moderate decrease of rCBF at initial scan, 6 cases had recurrent TIA or cerebral infarction and 2 cases did not have recurrence.Patients with more severe cerebral perfusion defects usually had a shorter interval time between two attacks.Conclusions Intensive intervention should be performed on patients with severe and long lasting decrease of cerebral perfusion.

Changes of Anterior Chamber Depth and Angle After Cataract Surgery Measured by Anterior Segment OCT

PURPOSE: To report the change of anterior chamber parameters according to cataract severity after cataract surgery and to determine its relationship to the severity of cataract by using anterior segment optical coherence tomography. METHODS: We measured the anterior chamber parameters in 19 eyes of 14 patients before, 1 week after, and 1 month after cataract surgery by slit lamp-adapted optical coherence tomography (SL-OCT). The measured parameters were as follows : the anterior chamber depth (ACD), the angle-opening distance 250 micrometer from the scleral spur (AOD250), the angle-opening distance 500 micrometer from the scleral spur (AOD500), and the trabecular-iris angle (TIA). We analyzed the relationship between the severity of cataract and the change of the anterior chamber parameters. RESULTS: The ACD, AOD250, AOD500, and TIA increased significantly at postoperative 1 week (P=0.000, 0.002, 0.005, 0.022) and 1 month (P=0.000, 0.004, 0.001, 0.002). The preoperative parameters were negatively correlated with the differences between the postoperative 1 week and preoperative parameters (gamma=-0.834, -0.591, -0.421, -0.826) and between postoperative 1 month and preoperative parameters (gamma=-0.659, -0.700, -0.770, -0.821). The change of parameters at postoperative 1 week (by N P=0.959, 0.916, 0.824, 1.000, by C P=0.454, 0.665, 0.578, 0.578) and 1 month (by N P=0.858, 0.973, 0.959, 0.959, by C P=0.999, 0.207, 0.950, 0.981) were not significantly different according to the severity of cataract (N, C). CONCLUSIONS: Our results showed that cataract surgery significantly deepened the anterior chamber and widened its angle. The shallower and narrower the preoperative anterior chamber depth and angle were, respectively, the greater the postoperative changes of anterior chamber depth and angle were.

Effect of urgent carotid endarterectomy on operative risk and benefit / 中国现代普通外科进展

Objectives:The time of Carotid intervention for recently symptomatic,severe carotid stenosis which cause a transient ischemic attack or minor stroke is still a controversial issue.Early studies showed that carotid endarterectomy (CEA) caused a high risk if performed within days follow an acute ischemic stroke.However,The National Stroke Strategy posted by UK Department of Health advocated that this situation should be regarded as an emergency procedure,and carotid intervention should ideally be performed within 48 hours.We designed this study to discuss the effect of urgent CEA on operative risk and benefit.Methods: we analyze 12 urgent CEA with primary closure performed during 1996 to 1998.All 12 patients were underwent CEA within 2 weeks,and 2 of them within 2 days.Operative risks and overall benefit from surgery were discussed in relation to the time from the last symptomatic event to CEA.Results: 2 urgent CEA performed in 2 days are recovery uneventful.1 of 12 patients,who underwent urgent CEA within 2 weeks,occurred restenosis after 3 months follow up.No 30-day perioperative recurrent TIA,stroke and death.Conclusions:CEA performed within 2 weeks is feasible and reliable procedure in preventing recurrent TIA and stroke after presenting manifestations.The future aim is to perform CEA within 48 hours after TIA or stroke symptoms.

Application of Spiral CT Perfusion Imaging and CT Angiography in Diagnosis of Transient Ischemic Attack / 中国康复理论与实践

@#Objective To use the multi-slice CT(MSCT)cerebral perfusion imaging and CT angiography(CTA)in the clinical diagnosis of transient ischemic attack(TIA).Methods 20 cases with transient ischemic attack within 48 h were examined with 16-slice CT perfusion imaging(CTPI)and CTA in head and neck.The interesting regional cerebral blood flow(rCBF),cerebral blood volume(rCBV)and the time to peak(rTP)were analyzed.Results The rTP of affected side delay compared with that of the healthy(t=3.04,P=0.008).CTA showed the responsible vascular stenosis or occlusion in varying degrees.There was not significant correlationship between rTP and vascular stenosis(r=0.32,P=0.17).Conclusion Cerebral perfusion imaging and head and neck CTA can provide valuable information for diagnosis and treatment of TIA.

Psychologic Investigation of Hypertensive with Transient Ischemic Attack: 56 Cases Report / 中国康复理论与实践

@#Objective To investigate the psychologic characteristics of the hypertensive with transient ischemic attack(TIA). Methods 56 hypertensive patients with TIA were surveyed with Symptom Checklist 90 (SCL-90), Eysenck Personality Questionnaire (EPQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS). Results and Conclusion The score in interpersonal sensitivity and paranoid factors of SCL-90 were below the norm obviously(P<0.05), the score of other factors were higher than the norm(P<0.01). Somatization, obsessive-compulsive, anxiety correlated negatively with E scale, while hostility, phobia anxiety, anxiety correlated positively with N scale. 71.4% patients appeared depression while 78.6% patients appeared anxiety in differently degree. Depression and anxiety correlated positively with the times of TIA, especially the anxiety.

Characteristics of Cerebral Artery Stenosis for Patients with Transient Ischemic Attack and Related Cardiovascular Risk Factors / 中国康复理论与实践

@#Objective To evaluate the localization and the correlation with cardiovascular risk factors of cerebral arteries damage in patients with transient ischemic attack (TIA). Methods Digital subtraction angiography (DSA) was performed in the 97 patients with TIA. The localization, the degree of stenosis, the numbers of the arteries involved and their correlation with the cardiovascular risk factors were analyzed. Results DSA showed occlusive findings of cerebral arteries in 91.8% of the patients, and 68 cases (76.4%) among them were involved more than one artery. The proximal internal carotid arteries (35.5%) and the proximal vertebral arteries (28.2%) were the most frequently involved in this series. And the number of the arteries involved and the degree of stenosis were positively correlated with the level of risk factors. Conclusion There is a high incidence of cerebrovascular stenosis in patients with TIA. Most of them are involved more than one artery. The degree of the stenosis is positively related with the quantity of the risk factors.

Comparison of Total Intravenous Anesthesia and Combined Inhalation and Intravenous Anesthesia in Lower Limbs Orthopedics for Patients with Cerebral Palsy / 中国康复理论与实践

@#Objective To compare the characteristics of total intravenous anesthesia (TIA) with manual assisted ventilation and combined inhalation and intravenous anesthesia (CIIA) with mechanical ventilation in lower limbs orthopedics for patients with cerebral palsy.Methods 50 patients with cerebral palsy undergoing scheduled lower limbs orthopedics were randomly divided into the TIA group and CIIA group with 25 cases in each group. The patients of the TIA group were treated with manual assisted ventilation. Those of the CIIA group were treated with fast induction, endotracheal intubation, inhalated and intravenous anesthetics maintaining the anesthesia and mechanical ventilation. The recovery time after operation and post-operative side effects including nausea, vomiting, and psychomotor agitation of all patients were observed.Results The recovery time of the patients in the CIIA group was significantly longer than that in the TIA group ( P<0.01), and post-operative psychomotor agitation was significantly higher than that in the TIA group ( P<0.05). However, there was no significant difference in nausea or vomiting found between two groups ( P>0.05).Conclusion Patients treated with TIA is easier to recovery and has fewer side effects than those treated with CIIA.

Relationship between Duration of Transient Ischemic Attacks and Prognosis:36 Case Report / 中国康复理论与实践

@#ObjectiveTo explore the relationship between the duration, MRI characters and prognosis in transient ischemic attack (TIA). Methods36 TIA cases were retrospectively analyzed according to the duration and Magnetic Resonance Imaging Diffusion Weighted Imaging(MRI-DWI). They were divided into two groups, Group A (13 cases) in which TIA continued within 1 h and Group B (23cases) in which TIA continued for 1～24 h. The patients were followed up 3 months and 12 months later. ResultsMRI abnormalities could be found with MRI-DWI in 2 cases in Group A, but 17 cases in group B(χ2=11.416,P=0.001). 1 case in Group A and 14 cases in Group B occurred cerebral infarction within a year(χ2=9.663,P=0.004). ConclusionThe longer TIA duration, the worse the prognosis.

Clinical Efficacy of Angioplasty for 26 Patients Suffered from Trunsient Ischemic Affack of Vertebrobasilay System / 医学研究杂志

Objective To evaluate the recent curative effect of the angioplasty of vertebrobasilar system TIA patients.Methods 26 patients of vertebrobasilar system TIA after accepting angioplasty were analyzed retrospectively and were followed-up during 6 months to 9 months with average(7?0.25)months.We analyzed the short-period curative effect of the angioplasty and risk factors.Results 26 patients were accepted angioplasty of 31 vessels,with achievement ratio of technique being 100%,mean preoperative stenosis(82.50?9.95)% reducing to(4.2?3.8)%.1 patient appeared transient ischemic attacked following-up for 6~9months.The symptom disappeared in 24 patients.2 patients relapsed.One was related to take medicine irregularly,the other was related to the hypertension.Conclusion The recent curative effect of angioplasty to vertebrobasilar system TIA patients was satisfactory,but long-ferm efficacy needs to be observed in the further.