ABSTRACT
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.
