Abstract
Forty six patients aged 18-39 years with transient ischaemic attacks (TIA) were studied; two thirds were women. Twenty five patients had attacks accompanied by headache, and seven gave a history of common migraine. Only four of 27 angiograms were abnormal; no operable carotid lesion was demonstrated. Over a mean follow up period of 10 years stroke or myocardial infarction (AMI) occurred in all four patients who presented major cerebrovascular risk factors, but in only two of the remaining 42 patients. Thus irrespective of age thromboembolic TIA is a harbinger of stroke or AMI. However, most TIAs under the age of 40 years are caused by a non-embolic benign vascular disorder. The clinical characteristics, long-term prognosis, and possible pathogenesis, for such attacks are often indistinguishable from those of classical migraine. In the absence of cardiovascular risk factors, arteriography does not provide much diagnostic and prognostic information.
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- A classification and outline of cerebrovascular diseases. II. Stroke. 1975 Sep-Oct;6(5):564–616. doi: 10.1161/01.str.6.5.564. [DOI] [PubMed] [Google Scholar]
- Baker R. N., Ramseyer J. C., Schwartz W. S. Prognosis in patients with transient cerebral ischemic attacks. Neurology. 1968 Dec;18(12):1157–1165. doi: 10.1212/wnl.18.12.1157. [DOI] [PubMed] [Google Scholar]
- Bogousslavsky J., Hachinski V. C., Boughner D. R., Fox A. J., Viñuela F., Barnett H. J. Clinical predictors of cardiac and arterial lesions in carotid transient ischemic attacks. Arch Neurol. 1986 Mar;43(3):229–233. doi: 10.1001/archneur.1986.00520030021006. [DOI] [PubMed] [Google Scholar]
- Edmeads J. The headache of ischemic cerebrovascular disease. Headache. 1979 Sep;19(6):345–349. doi: 10.1111/j.1526-4610.1979.hed1906345.x. [DOI] [PubMed] [Google Scholar]
- Egeblad H., Soelberg Sørensen P. Prevalence of mitral valve prolapse in younger patients with cerebral ischaemic attacks. A blinded controlled study. Acta Med Scand. 1984;216(4):385–391. doi: 10.1111/j.0954-6820.1984.tb03822.x. [DOI] [PubMed] [Google Scholar]
- Fisk factors in stroke due to cerebral infarction. A statement for physicians. Stroke. 1971 Sep-Oct;2(5):423–428. [PubMed] [Google Scholar]
- Friberg L., Olsen T. S., Roland P. E., Lassen N. A. Focal ischaemia caused by instability of cerebrovascular tone during attacks of hemiplegic migraine. A regional cerebral blood flow study. Brain. 1987 Aug;110(Pt 4):917–934. doi: 10.1093/brain/110.4.917. [DOI] [PubMed] [Google Scholar]
- Goldner J., Wisnant J. P., Taylor W. F. Long-term prognosis of transient cerebral ischemic attacks. Stroke. 1971 Mar-Apr;2(2):160–167. doi: 10.1161/01.str.2.2.160. [DOI] [PubMed] [Google Scholar]
- Grindal A. B., Toole J. F. Headache and transient ischemic attacks. Stroke. 1974 Sep-Oct;5(5):603–606. doi: 10.1161/01.str.5.5.603. [DOI] [PubMed] [Google Scholar]
- Hurwitz B. J., Heyman A., Wilkinson W. E., Haynes C. S., Utley C. M. Comparison of amaurosis fugax and transient cerebral ischemia: a prospective clinical and arteriographic study. Ann Neurol. 1985 Dec;18(6):698–704. doi: 10.1002/ana.410180612. [DOI] [PubMed] [Google Scholar]
- Johnson S. E., Skre H. Transient cerebral ischemic attacks in the young and middle aged. A population study. Stroke. 1986 Jul-Aug;17(4):662–666. doi: 10.1161/01.str.17.4.662. [DOI] [PubMed] [Google Scholar]
- Landi G., Guidotti M., Valsecchi F. Influence of age on carotid atheroma in patients with reversible ischemic attacks. Stroke. 1987 Jan-Feb;18(1):43–45. doi: 10.1161/01.str.18.1.43. [DOI] [PubMed] [Google Scholar]
- Lauritzen M., Skyhøj Olsen T., Lassen N. A., Paulson O. B. Changes in regional cerebral blood flow during the course of classic migraine attacks. Ann Neurol. 1983 Jun;13(6):633–641. doi: 10.1002/ana.410130609. [DOI] [PubMed] [Google Scholar]
- Lidegaard O., Soe M., Andersen M. V. Cerebral thromboembolism among young women and men in Denmark 1977-1982. Stroke. 1986 Jul-Aug;17(4):670–675. doi: 10.1161/01.str.17.4.670. [DOI] [PubMed] [Google Scholar]
- Marshall J., Wilkinson I. M. The prognosis of carotid transient ischaemic attacks in patients with normal angiograms. Brain. 1971;94(3):395–402. doi: 10.1093/brain/94.3.395. [DOI] [PubMed] [Google Scholar]
- Medina J. L., Diamond S., Rubino F. A. Headaches in patients with transient ischemic attacks. Headache. 1975 Oct;15(3):194–197. doi: 10.1111/j.1526-4610.1975.hed1503194.x. [DOI] [PubMed] [Google Scholar]
- Mendelowitz D. S., Kimmins S., Evans W. E. Prognosis of patients with transient ischemic attacks and normal angiograms. Arch Surg. 1981 Dec;116(12):1587–1591. doi: 10.1001/archsurg.1981.01380240067010. [DOI] [PubMed] [Google Scholar]
- Muuronen A., Kaste M. Outcome of 314 patients with transient ischemic attacks. Stroke. 1982 Jan-Feb;13(1):24–31. doi: 10.1161/01.str.13.1.24. [DOI] [PubMed] [Google Scholar]
- Peatfield R. C. Can transient ischaemic attacks and classical migraine always be distinguished? Headache. 1987 May;27(5):240–243. doi: 10.1111/j.1526-4610.1987.hed2705240.x. [DOI] [PubMed] [Google Scholar]
- Pessin M. S., Duncan G. W., Mohr J. P., Poskanzer D. C. Clinical and angiographic features of carotid transient ischemic attacks. N Engl J Med. 1977 Feb 17;296(7):358–362. doi: 10.1056/NEJM197702172960703. [DOI] [PubMed] [Google Scholar]
- Poole C. J., Ross Russell R. W., Harrison P., Savidge G. F. Amaurosis fugax under the age of 40 years. J Neurol Neurosurg Psychiatry. 1987 Jan;50(1):81–84. doi: 10.1136/jnnp.50.1.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Portenoy R. K., Abissi C. J., Lipton R. B., Berger A. R., Mebler M. F., Baglivo J., Solomon S. Headache in cerebrovascular disease. Stroke. 1984 Nov-Dec;15(6):1009–1012. doi: 10.1161/01.str.15.6.1009. [DOI] [PubMed] [Google Scholar]
- Simonsen N., Christiansen H. D., Heltberg A., Marquardsen J., Pedersen H. E., Sørensen P. S. Long-term prognosis after transient ischemic attacks. Acta Neurol Scand. 1981 Mar;63(3):156–168. doi: 10.1111/j.1600-0404.1981.tb00768.x. [DOI] [PubMed] [Google Scholar]
- Sørensen P. S., Marquardsen J., Pedersen H., Heltberg A., Munck O. Long-term prognosis and quality of life after reversible cerebral ischemic attacks. Acta Neurol Scand. 1989 Mar;79(3):204–213. doi: 10.1111/j.1600-0404.1989.tb03740.x. [DOI] [PubMed] [Google Scholar]
- de Bono D. P., Warlow C. P. Potential sources of emboli in patients with presumed transient cerebral or retinal ischaemia. Lancet. 1981 Feb 14;1(8216):343–346. doi: 10.1016/s0140-6736(81)91669-x. [DOI] [PubMed] [Google Scholar]