[Vertebrobasilar transient ischemic attacks in young and middle aged patients].

A complex clinical, neurological, laboratory, ultrasound and neuroimaging examination of 70 patients, aged 31-59 years, suffering from vertebrobasilar transient ischemic attack (TIA) was carried out in order to determine clinical and pathogenetic peculiarities of the disease in young and middle aged patients. The hemodynamically significant atherosclerotic lesion of the large cerebral arteries (LCA) as a cause of TIA was observed more rarely in the young and middle age groups than in elderly and aged people. Heart valves lesion was the main cause of cerebral cardioembolism in young and middle aged patients with TIA. A greater number of cases with other established causes of the disease (dissections, kinking of vertebral arteries, hemorheological microocclusion) were revealed. An undetermined pathogenesis of the disease mostly due to the inability to choose the main pathogenetic mechanism out of other potential mechanisms, e.g., the association of arterial hypertension with kinking, the hypoplasia or anomaly of the entrance of vertebral artery into the transverse channel, was observed in these groups more often than in elderly and aged people. The clinical picture of TIA in young and middle aged patients with hemodynamically significant atherosclerotic lesion of LCA had the highest similarity with that in elderly and aged ones. In case of cardioembolic pathogenesis, it was characterized by the markedly less severe signs of the disease and in case of the disease due to isolated arterial hypertension--by the lower rate of vascular white matter abnormalities on neuroimaging. A relatively higher rate of symptoms attributed to the manifestation of hypertensive crisis during the attack was observed in young and middle aged patients with TIA due to isolated arterial hypertension comparing with other pathogenetic variants of the disease. The clinical picture of TIA due to other established causes was depended on the main pathogenetic mechanism of the disease.

[Clinical peculiarities of pathogenetic subtypes of vertebrobasilar transient ischemic attacks in elderly and aged patients].

To determine the peculiarities of clinical presentations of vertebrobasilar transient ischemic attacks in elderly and aged patients (42 patients aged 61-90 years) have been studied using clinical, laboratory, neuroimaging and ultrasound methods. Hemodynamically significant stenosis of vertebral or basilar arteries caused by atherosclerosis was found in 16 patients. It was associated with hypoplasia or kinking of vertebral arteries in 4 patients. Six patients had atrial fibrillation, 15 isolated arterial hypertension and 4 an unspecified type of the disease. Transient ischemic attacks in patients with hemodynamically significant stenosis of vertebral or basilar arteries were characterized by the highest rate and shortest duration of repeated attacks. The most severe clinical course was characteristic of transient ischemic attacks in patients with atrial fibrillation. It was featured by the longest duration of symptoms, highest rate of vision loss, limb numbness and weakness during the attack, high rate of focal neurological signs and high rate of old cerebral infarcts and vascular white matter abnormalities on neuroimages as well as the elevated plasma level of C-reactive protein. Transient ischemic attacks in patients with isolated arterial hypertension were characterized by relatively mild clinical course of the disease.