Recurrent Transient Ischemic Attacks Revealing Cerebral Amyloid Angiopathy: A Comprehensive Case

This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.

Transient ischemic attack induced by pulmonary arteriovenous fistula in a child:A case report

BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.

Diagnostic value of ABCD2 and ABCD3-Ⅰ risk scoring systems in determining one-month risk of stroke in patients with transient ischemic attack: An observational study

Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.

Cerebral perfusion in corresponding blood supply areas of transient ischemic attack patients with intracranial stenosis Seven cases of diamox-perfusion verified by magnetic resonance-perfusion-weighted imaging

BACKGROUND： Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral peffusion. Therefore, according to degree of stenosis and clinical symptoms, interventional surgery to relieve arterial stenosis in transient ischemic attack （TIA） patients with major intracranial stenosis is imprudent. Rather, cerebral perfusion and reserve capacity are direct indicators for the assessment of degree and presence of cerebral ischemia. OBJECTIVE： To evaluate cerebral perfusion and reserve in TIA patients with major intracranial stenosis or occlusion using magnetic resonance-perfusion-weighted imaging （MR-PWl） data prior to and following diamox administration. DESIGN, TIME AND SETTING： A self-comparative, neuroimaging observation was performed at the Neurological Department and Radiological Center of the First Affiliated Hospital of Jinan University between December 2007 and April 2009. PARTICIPANTS： Seven acute TIA patients, who were admitted to the Neurological Department of the First Affiliated Hospital of Jinan University between December 2007 and April 2009, were enrolled in the present study. Magnetic resonance imaging confirmed that no acute cerebral infarction happened, nor did bleeding exist. Magnetic resonance angiography, transcranial Doppler ultrasound, and/or digital subtraction angiography confirmed the presence of major intracranial arterial stenosis. Clinical symptoms corresponded to blood supplying regions of the arterial stenosis. METHODS： Baseline MR-PWI was performed on seven patients with intracranial stenosis or occlusion. Two grams of acetazolamide （diamox） were orally administered after 2 days. A second PWl was performed after 2 hours to compare cerebral perfusion parameters prior to and following diamox administration. MAIN OUTCOME MEASURES： PWI results of cerebral perfusion prior to and following diamox administration. RESULTS： The baseline PWl from five patients indicated decreased cerebral perfusion areas. Following oral administration of diamox, cerebral perfusion significantly decreased in those areas. Moreover, new areas of decreased cerebral perfusion were observed in two out of the five patients. In one patient, no significant decrease in cerebral perfusion was found. In another patient, baseline PWl indicated decreased cerebral perfusion in the left hemisphere. However, normal perfusion was observed in both cerebral lobes following diamox administration. CONCLUSION： TIA patients with intracranial stenosis, who are diagnosed by PWI and exhibited decreased cerebral perfusion and reserve, might require further treatment such as intervention by angioptasty.

Yizhi Xingnao prescription improves the cognitive function of patients after a transient ischemic attack

Patients with mild cognitive impairment after a transient ischemic attack were included in this study. They were treated with Yizhi Xingnao prescription, ergoloid mesylates or aspirin for 60 days. Evaluation using the Montreal Cognitive Assessment Scale showed that cognitive function was significantly improved in all patients, especially after the combined treatment of Yizhi Xingnao and aspirin. The scores from the Montreal Cognitive Assessment Scale were improved overall and the effective treatment rate was as high as 79%, which was higher than patients treated with a combination of ergoloid mesylates and aspirin, or aspirin alone. Our experimental findings indicate that YizhiXingnao prescription can improve mild cognitive impairment after a transient ischemic attack, and that it is more effective than ergoloid mesylates.

Clinical analysis on neuroprotection of transient ischemic attacks

Transient ischemic attack（TIA） is an acute cerebrovascular incident,and is generally considered the best opportunity for early neuroprotective treatment against cerebral ischemia.This study retrospectively analyzed 80 patients with TIA（38 males and 42 females）.Among 61 patients who received neuroprotective cerebrolysin treatment within 24 hours after TIA onset,13（21.31%） patients suffered subsequent strokes.Among 19 patients who received neuroprotective cerebrolysin treatment within 24-72 hours after TIA onset,seven（36.84%） developed cerebral infarction.There was a significant difference in the proportion of subsequent strokes between patients receiving cerebrolysin treatment within 24 hours and 24-72 hours after TIA onset（P = 0.438）.These findings suggest that neuroprotective drugs administrated within 24 hours after TIA onset help reduce the incidence of subsequent strokes.The results demonstrate usefulness of the ABCD2 score at TIA patients in the determination of short-term and long-term cerebrovascular risk,including the frequency of subsequent ischemic cerebral infarctions up to 12 months.

Wall shear stress can improve prediction accuracy for transient ischemic attack

BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited. AIM To explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction. METHODS A total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTS The intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy)(P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC]< 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively. CONCLUSION WSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.

Executive function during transient ischemic attacks

BACKGROUND： Recent researches demonstrate that damage of executive function is an early manifestation of vascular cognitive disorder. OBJECTIVE： To investigate the executive functions of patients with transient ischemic attack （TIA）. DESIGN： Case control. SETTING： Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College. PARTICIPANTS： A total of 83 TIA patients （46 males and 37 females, aged 32 - 74 years） were selected from Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College from July 2005 to December 2006. The diagnosis of TIA was established by the criteria of cerebrovascular diseases made by the Fourth National Cerebrovascular Disease Meeting. In these cases, forty-five patients （54%） were involved in internal carotid artery, and thirty-eight patients （46%） were involved in vertebral basilar system. Fifty healthy adults （Control group： 28 males and 22 females, aged 32 - 74 years） were chosen from retiree in community and family of patients. All of them were right-handedness, without cerebrovascular disease, cerebral trauma, inborn oligophrenia, and heating and visual disorders; also they had no anxiety and depression nearly one week. In addition, all the subjects cooperated with examination. METHODS： After TIA diagnosis, all patients received neuropsychological examination, including attention and inhibition, working memory, flexibility, planning and diversion, based on Stroop tests （C and CW） and the Wisconsin card sorting tests （WCST）. ① WCST test： The edition revised by Nelson was used. We would take the times of sorting, incorrect response, persistent incorrect response, and randomly incorrect response as the index of evaluation.② Stroop tests： The edition revised by Trenarry was used and this test had two types： form color and form color-word. Their incorrect response and response time were recorded for data analysis in the end. MAIN OUTCOME MEASURES： Results of WCST test and Stroop tests. RESULTS： A total of 83 TIA patients and 50 healthy subjects were involved in the final analysis. Items of Stroop tests, including response time of Stroop-C test, incorrect response of Stroop-C test, response time of Stroop-CW test and incorrect response of Stroop-CW test, and items of WCST, including incorrect response, persistent incorrect response and random incorrect response, between internal carotid artery system and vertebral basilar artery system were （93.87±24.39） s, 3.16±3.97, （228.46±68.13） s, 12.91 ± 10.56, 55.42± 20.38, 26.58± 10.41, 28.62±11.22; （96.76±24.75） s, 3.89±4.77, （223.46±72.54） s, 18.71 ± 13.80, 52.47 ±22.25, 28.82± 16.20, 23.39±9.72, respectively; this was higher than those in the control group [（52.10± 12.18） s, 1.68± 1.97, （134.86±34.15） s, 4.22±4.21, 32.46± 17.97, 14.42±8.47, 18.24± 10.24, P 〈 0.05 - 0.01]. Times of sorting of WCST between internal carotid artery system and vertebral basilar artery system were obviously lower than those in the control group （8.27±2.73, 8.66±2.77, 11.22±2.41, P 〈 0.01）. However, there were no significant differences between internal carotid artery system and vertebral basilar artery system （P 〉 0.05）. CONCLUSION： Patients with TIA have executive dysfunctions, and the dysfunctions have no difference between internal carotid artery system and vertebral basilar artery system.

Radix Ilicis Pubescentis total flavonoids ameliorates neuronal damage and reduces lesion extent in a mouse model of transient ischemic attack

Flavonoids are a major component in the traditional Chinese medicine Radix Ilicis Pubescentis.Previous studies have shown that the administration of Radix Ilicis Pubescentis total flavonoids is protective in cerebral ischemia.However,to our knowledge,no studies have examined whether the total flavonoids extracted from Radix Ilicis Pubescentis prevent or ameliorate neuronal damage following transient ischemic attacks.Therefore,Radix Ilicis Pubescentis total flavonoids question and the potential underlying mechanisms.Thus,beginning 3 days before the induction of a mouse model of transient ischemic attack using tert-butyl hydroperoxide injections,mice were intragastrically administered 0.3,0.15,or 0.075 g/kg of Radix Ilicis Pubescentis total flavonoids daily for 10 days.The results of spectrophotometric analyses demonstrated that Radix Ilicis Pubescentis total flavonoids enhanced oxygen free radical scavenging and reduced pathological alterations in the brain.Hematoxylin-eosin staining results showed that Radix Ilicis Pubescentis total flavonoids reduced hippocampal neuronal damage and cerebral vascular injury in this mouse model of transient ischemic attack.These results suggest that the antioxidant effects of Radix Ilicis Pubescentis total flavonoids alleviate the damage to brain tissue caused by transient ischemic attack.

Magnetic resonance imaging in patients with transient ischemic attack

Transient ischemic attack （TIA） is a temporary event, which portends a higher risk of a disabling stroke following the TIA. However, the evaluation and management of TIA vary worldwide and is debated and controversial. With the development of brain imaging, particularly diffusion weighted imaging-magnetic resonance imaging （DWI-MRI）, the diagnosis of TIA changed from time-based definition to a tissue-based one. DWI-MRI be-came a mandatory tool in the TIA workup. The DWI-MRI provides not only the evidence to distinguish between TIA and acute ischemic stroke, fur-thermore it predicts TIA patients who are at higher risk of disabling stroke, which can be prevented by an immediate evaluation and treatment of TLA.

Local cerebral blood perfusion correlates with nerve fibre integrity in transient ischemic attack patients with middle cerebral artery stenosis: a pilot study

Recent advances in neuroimaging contribute a lot to the accurate diagnosis and evaluation of cerebrovascular diseases. To explore the relationship among blood perfusion, metabolism and brain structure integrity, 6 Chinese transient ischemic attack (TIA) patients with middle cerebral artery (MCA) stenosis were examined by xenon-enhanced computed tomography (Xe-CT), magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to compare cerebral blood flow (CBF) values, (choline + creatine)/ N-acetyl aspartate [(Cho + Cr)/NAA] values and fractional anisotropy (FA) values in the MCA territory. Our results showed that CBF values significantly decreased in the ipsilateral basal ganglion regions in all 5 cases with unilateral MCA stenosis, with a corresponding decrease of FA values in the same region. In conclusion, decreased blood perfusion may indicate nerve fibre damage in the dominating regions of stenosed arteries.

Carotid Doppler and transcranial Doppler in diagnosing transient ischemic attack: A healthy control

BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.

Transient ischemic attack after mRNA-based COVID-19 vaccination during pregnancy:A case report

BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,especially cerebral venous sinus thrombosis,and may lead to stroke.Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications.We present the case of a 24-year-old pregnant woman with a transient ischemic attack(TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine(at 37 2/7 wk).CASE SUMMARY TIA occurred 13 d following the coronavirus disease vaccination.At 39 1/7 wk of pregnancy,the patient presented with sudden onset of right eye blurred vision with headache,dizziness with nausea,right-hand weakness,anomia,and alexia.The symptoms lasted 3 h;TIA was diagnosed.Blood test results revealed elevated D-dimer,cholesterol,and triglyceride levels.Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke.At pregnancy 37 6/7 wk,she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor.Body mass index on admission was 19.8 kg/m~2.Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities.The next day,a mature female baby weighing 2895 g and measuring 50 cm was delivered.Apgar scores were 8 and 9 in the first and fifth minutes.D-dimer levels decreased on postoperative day 4.After discharge,the autoimmune panel was within normal limits,including antinuclear and antiphospholipid antibodies.CONCLUSION TIA might be developed after the mRNA vaccines in pregnant women.

Research on Influence of Clopidogrel on Life Quality in Patients with Transient Ischemic Attack and its Influencing Factors

Purpose:To analyze the basic situation and health related quality of life(HRQOL)results of patients with transient ischemic attack(TIA),and to study the influencing factors of health related quality of life in patients receiving clopidogrel.Method:Divide the TIA patients into clopidogrel group,aspirin group and untreated group.Measure HRQOL scores of TIA patients using the short form 36 questionnaire(SF-36)scale and analyze influencing factors of HRQOL with one-way ANOVA and multivariate stepwise linear regression statistical methods.Results:The differences of HRQOL scores among three groups are of statistical significance(F=4.29,P=0.00).There is no difference in HRQOL score between clopidogrel group and aspirin group(t=5.35,P=0.00),but HRQOL scores of clopidogrel group and aspirin group are higher than those of the untreated group(t=6.14,P=0.00;t=5.16,P=0.00).The HRQOL scores of clopidogrel group are positively correlated with diet,exercise,gender and family harmony(P<0.05),but negatively correlated with diabetes,hypertension,smoking,drinking,hyperlipidemia,age,career and ABCD2 score(P<0.05).Conclusion:TIA patients who received secondary prevention with clopidogrel and aspirin show better life quality results than those who did not.There were many factors influencing clopidogrel's treatment effect.Paying attention to middle-aged and elderly,the obese,mental workers and female TIA patients,teach TIA patients to quit smoking,drinking and eating low-salt and low-fat food,actively treating their hypertension,hyperlipidemia and diabetes and laying emphasis on psychological counseling and exercise can significantly improve the treatment effect of clopidogrel.

以危险因素为指导制定的个体化预警管理方案对TIA患者预后的影响研究

目的探讨以危险因素为指导制定的个体化预警管理方案对短暂性脑缺血发作(TIA)患者预后的影响。方法纳入首都医科大学附属北京世纪坛医院神经内科2021年12月至2022年12月收治的TIA患者90例为研究对象,随机分为2组,每组45例。对照组采用常规干预,观察组采用以危险因素为指导制定的个体化预警管理方案,比较2组患者的干预效果。结果观察组药物治疗、疾病症状、运动、饮食、复查、规律休息等疾病相关知识掌握率优于对照组(P<0.05)。2组干预后的临床指标改善情况优于干预前,观察组优于对照组(P<0.05)。观察组用药、饮食与运动、定期复查、合理休息、负性情绪管理等依从性高于对照组(P<0.05)。观察组中,复发1例,复发率为2.22%,脑卒中发生0例,发生率为0.00%;对照组中,复发10例,复发率为22.22%,脑卒中发生8例,发生率为17.78%,观察组复发率和脑卒中发生率均低于对照组(P<0.05)。结论给予TIA患者以危险因素为指导制定的个体化预警管理方案,能提升患者的疾病认知水平及治疗依从性,改善患者临床指标,减少疾病复发和防止发生脑卒中事件。

医院主导下实施计划行为理论为基础的家庭健康管理改善TIA患者的自我效能研究

目的探讨计划行为理论为基础实施医院主导的家庭健康管理方案对短暂性脑缺血发作(TIA)患者自我效能的影响。方法选取2021年1月至2023年1月治疗的TIA患者102例,按照随机数表法分为观察组和对照组,每组51例。对照组给予常规护理健康管理干预,观察组在对照组基础上给予以计划行为理论为基础实施医院主导的家庭健康管理干预,对比2组患者干预前、干预1个月后自我效能、疾病知识问卷、健康行为态度、健康行为及日常生活能力(ADL)评分。结果干预1个月后2组患者自我效能评分均高于干预前,且观察组高于对照组(P<0.05);干预1个月后2组患者疾病知识问卷评分均高于干预前,且观察组高于对照组(P<0.05);干预1个月后2组患者健康行为态度评分均高于干预前,且观察组高于对照组(P<0.05);干预1个月后2组患者健康行为评分均高于干预前,且观察组高于对照组(P<0.05);干预1个月后2组患者ADL评分均高于干预前,且观察组高于对照组(P<0.05)。结论TIA患者中应用以计划行为理论为基础实施医院主导的家庭健康管理,可建立其疾病正确认知及积极行为态度,提高自我效能及日常生活能力,促进防治疾病健康管理行为的实施。

CTA结合临床特征预测中高海拔地区伴头颈部动脉粥样硬化的TIA患者脑梗死风险研究

目的 基于头颈部CTA结合临床特征,探讨中高海拔地区伴头颈部动脉粥样硬化的TIA患者1年内发生脑梗死的危险因素,并构建风险预测模型,评价其预测效能。方法 采用回顾性分析,连续纳入2018年1月—2021年9月青海省第五人民医院收治的TIA患者(居住海拔2000~3000 m),所有患者均经头颈部CTA证实存在动脉粥样硬化斑块。随访1年,根据是否发生脑梗死分为未梗死组与梗死组。首先对两组患者的临床资料和头颈部CTA检查结果进行单因素分析,筛选出有意义的变量,再通过多因素logistic回归分析脑梗死的独立影响因素,构建TIA后1年内发生脑梗死的风险预测模型以绘制ROC曲线。结果 初步纳入患者111例。随访中出现9例失访,1例于外院放置颈动脉支架,1例发生硬膜下血肿,均不符合最终的纳入标准。最终纳入100例患者,其中梗死组26例,未梗死组74例。单因素分析显示梗死组ABCD2评分高于未梗死组[4.00(3.75~5.00)分vs. 3.00(2.00~4.00)分,P=0.004];梗死组高血压分级>1级(69.23%vs. 41.89%,P=0.022)、具不稳定斑块(88.46%vs. 67.57%,P=0.039)、血管中重度狭窄(53.85%vs. 12.16%,P<0.001)和不稳定斑块累及血管数>1支(69.23%vs. 31.08%,P=0.001)的患者比例高于未梗死组,以上差异均有统计学意义。logistic回归分析显示,高血压分级>1级、ABCD2评分偏高及血管中重度狭窄是TIA后1年内发生脑梗死的独立危险因素,其风险预测模型为:P=1/[1+exp(-4.782+1.407×高血压分级+0.574×ABCD2评分+2.734×血管狭窄程度)]。该模型预测脑梗死的AUC为0.848(95%CI 0.763~0.933),敏感度为92.31%,特异度为70.27%。结论 高血压分级>1级、ABCD2评分偏高及血管中重度狭窄是中高海拔地区伴头颈部动脉粥样硬化的TIA患者1年内发生脑梗死的危险因素,三者联合构建的预测模型对脑梗死有良好的预测价值。

ADC值、FA值与TIA患者血管狭窄程度的相关性及其联合检测对TIA患者发生ACI的预测价值

目的 探究弥散加权成像(DWI)参数表现扩散系统(ADC)值、弥散张量成像(DTI)参数向异性分数(FA)值与短暂性脑缺血发作(TIA)血管狭窄程度的相关性,及联合检测对TIA患者发生急性脑梗死(ACI)的预测价值。方法 选取河南省第二人民医院2022年1月至2023年1月收治的110例TIA患者,均进行DWI、DTI检查。比较不同血管狭窄程度TIA患者ADC值、FA值,分析ADC值、FA值与TIA血管狭窄程度的相关性。根据TIA患者入院治疗后3个月内是否发生ACI,分为ACI组和非ACI组,分析ADC值、FA值联合检测对TIA患者发生ACI的预测价值。结果 血管狭窄程度轻度、中度、重度TIA患者ADC值、FA值比较:重度<中度<轻度(P<0.05);TIA患者ADC值、FA值与血管狭窄程度呈负相关(r=-0.786、-0.679,P<0.05);非ACI组ADC值、FA值高于ACI组(P<0.05);ADC值与FA值联合检测预测TIA患者发生ACI的AUC、敏感度均高于DC值、FA值单独检测(P<0.05)。结论 ADC值、FA值可用于评估TIA患者血管狭窄程度,且联合检测对TIA患者发生ACI具有较高的预测价值,临床常可通过DWI检查和DTI检查获取ADC值、FA值,用于评估TIA患者血管狭窄的严重程度,并预测ACI发生的可能性,为临床早期制定干预措施提供依据,进而减少ACI的发生,改善TIA患者的预后。

血清ICAM-1、LP-PLA2联合ABCD2评分对TIA发作患者短期预后的价值

目的 探讨血清细胞间黏附分子-1 (ICAM-1)、脂蛋白磷脂酶A2(LP-PLA2)联合ABCD2评分对短暂性脑缺血发作(TIA)患者短期预后的评估价值。方法 选取2020年1月至2022年2月海南医学院第一附属医院、海口市人民医院收治的98例TIA患者,根据发病90 d内是否发生脑梗死、心源性血栓等终点事件分为终点组和无终点组。对比两组血清ICAM-1、LP-PLA2水平及ABCD2评分差异,绘制ROC曲线分析三项指标对TIA患者发生终点事件的预测价值。结果 98例TIA患者中发生终点事件26例(26.53%),其中脑梗死8例,大动脉狭窄≥50%患者14例,心源性血栓4例。终点组症状持续时间≥60min患者比例、血清ICAM-1、LP-PLA2水平及ABCD2评分高于无终点组(P<0.05)。多因素Logistic分析显示,症状持续时间≥60min、血清ICAM-1及LP-PLA2高表达、ABCD2评分高是TIA患者出现终点事件的危险因素(P<0.05)。血清ICAM-1、LP-PLA2联合ABCD2评分预测TIA患者发生终点事件的曲线下面积为0.908。结论 血清ICAM-1、LP-PLA2水平与TIA患者不良终点事件的发生密切相关,ICAM-1、LP-PLA2联合ABCD2评分有助于早期预测TIA患者短期预后情况。

DCE-MRI定量参数联合ABCD2评分法对TIA发作后进展为脑梗死的诊断价值研究

目的:分析磁共振动态对比增强扫描(DCE-MRI)定量参数联合ABCD2评分法对短暂性脑缺血发作(TIA)后进展为脑梗死的诊断价值。方法:选取2020年12月—2022年12月在固原市中医医院就诊的100例TIA患者,根据是否进展为脑梗死将其分为观察组(30例进展为脑梗死)与对照组(70例未进展为脑梗死),比较两组DCE-MRI定量参数、ABCD2评分,比较不同ABCD2分层组DCE-MRI定量参数,绘制受试者工作特征曲线分析DCE-MRI定量参数、ABCD2评分对TIA进展为脑梗死的预测价值。结果:观察组rK_(ep)、rK^(trans)、rV_(e)均低于对比组(P<0.05),观察组ABCD2评分高于对比组(P<0.05)。高危组rK_(ep)、rK^(trans)、rVe均低于中危组、低危组(P<0.05)。rK_(ep)、rK^(trans)、rV_(e)、ABCD2评分联合预测的灵敏度(94.16%)高于单一检测(P<0.05)。结论:DCE-MRI定量参数联合ABCD2评分预测可提高TIA进展为脑梗死的预测灵敏度。