This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bisschops, R. H.C. Articles by van der Grond, J. Search for Related Content PubMed PubMed Citation Articles by Bisschops, R. H.C. Articles by van der Grond, J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB (L)-ASPARTIC ACID CHOLINE BITARTRATE CHOLINE CHLORIDE HYDROGEN LACTIC ACID Medline Plus Health Information Transient Ischemic Attack Related Collections Acute Stroke Syndromes Brain Circulation and Metabolism Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2002;33:110.)
© 2002 American Heart Association, Inc.

Original Contributions

Hemodynamic and Metabolic Changes in Transient Ischemic Attack Patients

A Magnetic Resonance Angiography and ¹H-Magnetic Resonance Spectroscopy Study Performed Within 3 Days of Onset of a Transient Ischemic Attack

Robertus H.C. Bisschops, MD; L.J. Kappelle, MD, PhD; Willem P.T.M. Mali, MD, PhD Jeroen van der Grond, PhD

From the Departments of Radiology (R.H.C.B., W.P.T.M.M., J. van der G.) and Neurology (L.J.K.), University Medical Center Utrecht, Utrecht, the Netherlands.

Correspondence to Robertus H.C. Bisschops, MD, Department of Radiology E01.132, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. E-mail r.h.c.bisschops{at}azu.nl

Background and Purpose— We investigated whether patients with transient ischemic attack (TIA) have systemic low flow to the brain or an abnormal intracranial flow distribution caused by an abnormal anatomy of the circle of Willis. Furthermore, we investigated whether metabolic changes were present in the brain.

Methods— Forty-four patients with clinically diagnosed TIA were prospectively included in our study. Clinical and neurological data were compiled. MR imaging; quantitative flow measurements of the internal carotid, middle cerebral, and basilar arteries; MR angiography of the circle of Willis; and ¹H-MR spectroscopy were performed in all patients within 3 days of onset of symptoms.

Results— Compared with control subjects, TIA patients did not have altered flow volume in any of the arteries and had normal flow distribution through the circle of Willis. In TIA patients, the N-acetylaspartate (NAA)/choline ratio in noninfarcted regions was significantly decreased in the symptomatic hemisphere (1.73±0.16) compared with the asymptomatic hemisphere (1.84±0.19, P<0.05) and control subjects (1.90±0.17, P<0.001). In the symptomatic hemisphere, the lactate/NAA ratio was significantly increased (0.04±0.08) compared with control subjects (0.00±0.01, P<0.05). Patients with a history of prior TIA had a significantly decreased NAA/choline ratio in both the symptomatic (P<0.05) and asymptomatic (P<0.05) hemispheres compared with TIA patients without a prior TIA.

Conclusions— TIA patients have neurological deficits that are transient; however, metabolic damage to the brain is present up to 3 days after the onset of the symptoms. These metabolic changes are not restricted to the symptomatic hemisphere or to areas close to ischemic lesions.

Key Words: ischemic attack, transient • magnetic resonance angiography • magnetic resonance spectroscopy

This article has been cited by other articles:

				J. D. Easton, J. L. Saver, G. W. Albers, M. J. Alberts, S. Chaturvedi, E. Feldmann, T. S. Hatsukami, R. T. Higashida, S. C. Johnston, C. S. Kidwell, et al. Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke, June 1, 2009; 40(6): 2276 - 2293. [Abstract] [Full Text] [PDF]

				P. Y. Takahashi, L. N. Dyrbye, K. G. Thomas, O. Quirindongo Cedeno, F. North, R. J. Stroebel, R. S. DeJesus, and P. V. Targonski The Association of Transient Ischemic Attack Symptoms With Memory Impairment Among Elderly Participants of the Third US National Health and Nutrition Examination Survey J Geriatr Psychiatry Neurol, March 1, 2009; 22(1): 46 - 51. [Abstract] [PDF]

				T. Bartsch, K. Alfke, S. Wolff, A. Rohr, O. Jansen, and G. Deuschl Focal MR spectroscopy of hippocampal CA-1 lesions in transient global amnesia Neurology, March 25, 2008; 70(13): 1030 - 1035. [Abstract] [Full Text] [PDF]

				K. M. Sicard, N. Henninger, M. Fisher, T. Q. Duong, and C. F. Ferris Long-Term Changes of Functional MRI-Based Brain Function, Behavioral Status, and Histopathology After Transient Focal Cerebral Ischemia in Rats Stroke, October 1, 2006; 37(10): 2593 - 2600. [Abstract] [Full Text] [PDF]

				F. Purroy, J. Montaner, A. Rovira, P. Delgado, M. Quintana, and J. Alvarez-Sabin Higher Risk of Further Vascular Events Among Transient Ischemic Attack Patients With Diffusion-Weighted Imaging Acute Ischemic Lesions Stroke, October 1, 2004; 35(10): 2313 - 2319. [Abstract] [Full Text] [PDF]

				B. Ovbiagele, C. S. Kidwell, and J. L. Saver Epidemiological Impact in the United States of a Tissue-Based Definition of Transient Ischemic Attack Stroke, April 1, 2003; 34(4): 919 - 924. [Abstract] [Full Text] [PDF]