Prognostic value of the ABCD2 score beyond short-term follow-up after transient ischemic attack (TIA)--a cohort study.

BACKGROUND: Transient ischemic attack (TIA) patients are at a high vascular risk. Recently the ABCD2 score was validated for evaluating short-term stroke risk after TIA. We assessed the value of this score to predict the vascular outcome after TIA during medium- to long-term follow-up. METHODS: The ABCD2 score of 176 TIA patients consecutively admitted to the Stroke Unit was retrospectively calculated and stratified into three categories. TIA was defined as an acute transient focal neurological deficit caused by vascular disease and being completely reversible within 24 hours. All patients had to undergo cerebral MRI within 5 days after onset of symptoms as well as extracranial and transcranial Doppler and duplex ultrasonography. At a median follow-up of 27 months, new vascular events were recorded. Multivariate Cox regression adjusted for EDC findings and heart failure was performed for the combined endpoint of cerebral ischemic events, cardiac ischemic events and death of vascular or unknown cause. RESULTS: Fifty-five patients (32.0%) had an ABCD2 score < or = 3, 80 patients (46.5%) had an ABCD2 score of 4-5 points and 37 patients (21.5%) had an ABCD2 score of 6-7 points. Follow-up data were available in 173 (98.3%) patients. Twenty-two patients (13.8%) experienced an ischemic stroke or TIA; 5 (3.0%) a myocardial infarction or acute coronary syndrome; 10 (5.7%) died of vascular or unknown cause; and 5 (3.0%) patients underwent arterial revascularization. An ABCD2 score > 3 was significantly associated with the combined endpoint of cerebral or cardiovascular ischemic events, and death of vascular or unknown cause (hazard ratio (HR) 4.01, 95% confidence interval (CI) 1.21 to 13.27). After adjustment for extracranial ultrasonographic findings and heart failure, there was still a strong trend (HR 3.13, 95% CI 0.94 to 10.49). Whereas new cardiovascular ischemic events occurred in 9 (8.3%) patients with an ABCD2 score > 3, this happened in none of the 53 patients with a score < or = 3. CONCLUSIONS: An ABCD2 score > 3 is associated with an increased general risk for vascular events in the medium- to long-term follow-up after TIA.

Transcranial Doppler ultrasonography predicts cardiovascular events after TIA.

BACKGROUND: Transient ischemic attack (TIA) patients are at high vascular risk. We assessed the value of extracranial (ECD) and transcranial (TCD) Doppler and duplex ultrasonography to predict clinical outcome after TIA. METHODS: 176 consecutive TIA patients admitted to the Stroke Unit were recruited in the study. All patients received diffusion-weighted imaging, standardized ECD and TCD. At a median follow-up of 27 months, new vascular events were recorded. RESULTS: 22 (13.8%) patients experienced an ischemic stroke or TIA, 5 (3.1%) a myocardial infarction or acute coronary syndrome, and 5 (3.1%) underwent arterial revascularization. ECD revealed extracranial > or = 50% stenosis or occlusions in 34 (19.3%) patients, TCD showed intracranial stenosis in 15 (9.2%) and collateral flow patterns due to extracranial stenosis in 5 (3.1%) cases. Multivariate analysis identified these abnormal ECD and TCD findings as predictors of new cerebral ischemic events (ECD: hazard ratio (HR) 4.30, 95% confidence interval (CI) 1.75 to 10.57, P = 0.01; TCD: HR 4.73, 95% CI 1.86 to 12.04, P = 0.01). Abnormal TCD findings were also predictive of cardiovascular ischemic events (HR 18.51, 95% CI 3.49 to 98.24, P = 0.001). CONCLUSION: TIA patients with abnormal TCD findings are at high risk to develop further cerebral and cardiovascular ischemic events.

Cerebral vasculitis mimicking migraine with aura in a patient with Crohn's disease.

INTRODUCTION: Whereas extraintestinal manifestations of inflammatory bowel disease in general are quite common, cerebral vasculitis is considered a very rare condition. We present a case of Crohn's disease-associated vasculitis mimicking migraine with aura. CASE DESCRIPTION: A 28-year-old woman with Crohn's disease and known migraine with aura had suffered from daily migraine attacks with recurrent focal neurological deficits for 6 weeks. Cerebral magnetic resonance imaging showed multiple acute, subacute, and chronic ischemic lesions in different vascular territories. Magnetic resonance and computed tomography angiography demonstrated vessel changes consistent with cerebral vasculitis. Laboratory investigations revealed systemic inflammation and lymphomonocytic pleocytosis of cerebrospinal fluid, supporting the diagnosis of Crohn's disease-associated vasculitis. Symptoms and inflammatory parameters quickly normalized after high-dose prednisolone treatment. During immunosuppressive therapy, migraine recurred only once in 11 months. DISCUSSION: Cerebral vasculitis is a very rare but severe complication in Crohn's disease and should be excluded in case of comorbidity with migraine with aura. In our patient, migraine with aura may have been the only symptom of cerebral vasculitis for several years.