Clinical identification of TIAs due to carotid stenosis (original) (raw)
Related papers
Nonfocal transient neurological attacks in patients with carotid artery occlusion
European Stroke Journal
Introduction Nonfocal transient neurological attacks (TNAs) are episodes with atypical, nonlocalizing cerebral symptoms. We examined the prevalence of nonfocal TNAs, in patients with and without carotid artery occlusion (CAO). Methods We included 67 patients with CAO and 62 patients without CAO. In both groups, patients had a history of transient ischemic attack (TIA) or nondisabling ischemic stroke in the anterior circulation that had occurred >6 months before inclusion. Patients without CAO did not have ipsilateral or contralateral carotid artery stenosis of ≥50%. All patients were interviewed with a standardized questionnaire on the occurrence of nonfocal TNA symptoms during the preceding six months. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for the occurrence of ≥1 and ≥2 different nonfocal TNAs after adjustments for age, sex, systolic blood pressure and time interval between most recent TIA or ischemic stroke and administration of the questionnaire....
Heart and Vessels, 1987
We evaluated the correlation of clinical and echo-Doppler findings from the internal carotid artery (ICA) in 17 patients with amaurosis fugax (AF) and in 68 patients with hemispheric TIA (H-TIA). In the study population as a whole, moderate stenoses (20%-49% diameter reduction) were the most prevalent finding in the symptomatic ICA, being detectable in 51.6 % of cases. Total occlusions were found in an unexpectedly high percentage (7.5%). Asymptomatic ICAs, that were contralateral to the symptoms, showed the same degree of atherosclerotic involvement as the symptomatic ICAs.
Carotid transient ischemic attacks presenting as limb-shaking syndrome: report of two cases
Arquivos de Neuro-Psiquiatria, 2004
Limb shaking syndrome (LSS) is a rare presentation of transient ischemic attacks (TIAs), usually secondary to a critical carotid stenosis compromising intracranial circulation, first described 40 years ago. Two additional cases are described herein, aiming to add on to previous descriptions, and to warn physicians about this potentially harming and rather uncommon condition.
Limb-Shaking Transient Ischemic Attacks Successfully Treated with External Carotid Artery Stenting
Case Reports in Medicine, 2012
The external carotid artery (ECA) is one of the most important extracranial-to-intracranial sources of collateral circulation, contributing significantly to the cerebral blood flow especially when perfusion through the internal carotid artery (ICA) is compromised. Most of the endovascular studies so far have been dedicated to ICA, with little focus on the ECA. Limb-shaking transient ischemic attacks (TIAs) are a relatively rare manifestation of carotid artery disease that may present with repetitive shaking movements of the affected limbs. We report a case of an 80-year-old male with bilateral internal and contralateral external carotid artery occlusion who developed limb-shaking TIAs as a result of significant stenosis of the right ECA. Percutaneous revascularization of the ECA was performed by angioplasty and stenting. At the follow-up 12 months later, the patient remained neurologically intact with complete resolution of his symptoms. Stenting of the ECA should be considered as a reasonable alternative to conventional open repair especially in patients with contralateral carotid stenosis, insufficient circle of Willis, and significant comorbidities.
Complete Internal Carotid Artery Occlusion Presenting as "Seizures
Articles © The authors | Journal compilation © J Neurol Res and Elmer Press™ | www.neurores.org J Neurol Res • 2012;2(6):244-246 Press Elmer This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Abstract Limb shaking is a rare and atypical presentation for a transient ischemic attack. It can be described as a "cerebral ischemic clau-dication" due to attenuation in an already compromised cerebral perfusion. The uncharacteristic presentation may lead to confusion and misdiagnosis, for example, focal epilepsy, delaying appropriate therapy. We describe such a case highlighting the clinical impli-cations and options for addressing the underlying cerebrovascular pathology. A 57-years-old female with a 2 weeks history of slurred speech and involuntary shaking of the right upper and lower ex-tremities lasting f...
Therapy for Isolated, Low and High Grade Symptomatic Carotid Artery Stenosis
Annals of Vascular Surgery, 1988
This study evaluates whether medical therapy alone can achieve satisfactory results In the treatment of low grade carotid stenosis or ulcerated plaques. Out of 525 patients presenting with transient or minor strokes, 64 were found with unilateral extracranlal vascular disease as the sole potential source for their neurological symptoms. Utilizing arterlographlc criteria, 35 patients with ulcerated plaques or carotid artery stenosis of less than 50% luminal artery diameter were treated conservatively with aspirin and dipyridamole (300 mg/day each). Twenty-nine patients with unilateral internal carotid artery stenosis of greater than 50% luminal artery diameter were treated by means of carotid endarterectomy. Follow-up in the two groups for a mean period of 24-26 months revealed no major strokes or neurological deaths in either group. Myocardial infarction was the major cause of death. Two patients developed subsequent transient ischemic attacks, and one a minor stroke with total recovery in the conservatively treated group. All became asymptomatic when warfarin replaced aspirin therapy. The fIndings In this study confirmed that "low grade" stenoses can be safely treated by medical measures alone. KEY WORDS: Carotid stenosis; carotid endarterectomy; isolated carotid artery stenosis; transient ischemic attacks; high and low grade carotid stenosis. Carotid endarterectomy as a form of therapy in patients presenting with transient ischemic attacks (TIAs) and reversible ischemic neurological deficits remains the subject of much debate. In patients presenting with symptomatic carotid artery lesions, both medical [1] and surgical therapy [2] have been demonstrated to reduce the subsequent incidence of TIA and stroke below the level expected in natural history studies [3]. However, the conflicting results obtained in various trials of medical therapy may be accounted for by the failure to adequately and accurately identify the etiologic mechanism of the symptoms being treated [1,4,5].
Carotid Stenosis: Factors Affecting Symptomatology
Stroke, 2001
Background and Purpose-The ability to predict future strokes in asymptomatic patients with carotid stenosis is currently limited. The management of symptomatic patients with Ͻ50% stenosis is also debatable. In this context, we performed the following open prospective study to identify factors affecting symptomatology in patients with carotid stenosis. Methods- During 1988During -1997 arteries with various degrees of stenosis were followed with the use of color Duplex ultrasonography every 6 months. The main outcome measures were development of symptoms related to the carotid territory and progression in the degree of stenosis. Results of follow-up were analyzed in relation to the traditional risk factors for atherosclerosis as well as the ultrasonographic characteristics of the plaques. Statistical analysis was performed by multiple linear and Cox regression analysis. Results-Mean duration of follow-up was 44 months (range, 12 to 120 months). Significant progression of stenosis occurred in 18.5% of the cases and was more frequent in younger patients (Pϭ0.09), in patients with coronary artery disease (Pϭ0.02), and in patients with echolucent plaques (Pϭ0.02). In regard to clinical presentation, men (Pϭ0.07), hypertensives (Pϭ0.07), and patients with echolucent plaques (Pϭ0.09) showed a trend toward higher frequency of stroke in their history. During the follow-up period, neurological events developed in 12.4% of the cases and were associated with the severity of carotid disease (PϽ0.001), history of neurological events (Pϭ0.02), progression of stenosis (Pϭ0.002), echolucent plaques (Pϭ0.01), and hypertension (Pϭ0.02). Conclusions-Factors other than degree of stenosis and history of neurological events are also important in determining high-risk carotid plaque. In our study hypertension, echolucent plaques, and progressive lesions were associated with an increased risk of neurological events. These factors should be taken into consideration in determining treatment strategies for carotid stenosis. (Stroke. 2001;32:2782-2786.)