This Article Full Text Full Text (PDF) All Versions of this Article: 34/10/2446    most recent 01.STR.0000090842.81076.68v1 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 Johnston, S. C. Articles by Easton, J. D. Search for Related Content PubMed PubMed Citation Articles by Johnston, S. C. Articles by Easton, J. D. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Transient Ischemic Attack Related Collections Acute Cerebral Infarction Acute Stroke Syndromes Transient Ischemic Attacks

(Stroke. 2003;34:2446.)
© 2003 American Heart Association, Inc.

Original Contributions

Are Patients With Acutely Recovered Cerebral Ischemia More Unstable?

From the Neurovascular Service, Department of Neurology, University of California at San Francisco (S.C.J.), and Department of Neurology, Brown University, Providence, RI (J.D.E.).

Correspondence to S. Claiborne Johnston, MD, PhD, Department of Neurology, Box 0114, University of California at San Francisco, 505 Parnassus Ave, M-798, San Francisco, CA 94143-0114. E-mail clay.johnston{at}ucsfmedctr.org

Background and Purpose— Recent studies suggest that the short-term risk of stroke may be greater after transient ischemic attack (TIA) than after stroke.

Methods— We compared risks of neurological deterioration in those with and without TIA in the National Institute of Neurological Disorders and Stroke (NINDS) tissue plasminogen activator (tPA) trial, a randomized trial of intravenous tPA given within 3 hours of onset of cerebral ischemia, after excluding those with cerebral hemorrhage and those dying before 90 days of causes other than new ischemic stroke. TIA was defined as a National Institutes of Health Stroke Scale (NIHSS) score of zero at 24 hours. We chose subsequent deterioration as our outcome, defined as a worsening on the NIHSS at 90 days compared with 24 hours, so that episodes of new ischemia that may have been attributed to other causes would be included.

Results— Of 498 subjects meeting entry criteria, 40 (8%) had TIA. Subsequent deterioration occurred in 30% of those with TIA and 10% of others (P=0.001, Fisher exact test). In multivariable models with adjustment for age, sex, ethnicity, 24-hour NIHSS score, tPA administration, presumed stroke subtype, and baseline systolic blood pressure, temperature, and glucose, TIA was an independent predictor of subsequent deterioration (odds ratio, 5.0; 95% CI, 2.0 to 12.5; P=0.001). Subsequent deterioration was not associated with tPA treatment, and there was no interaction between tPA administration, TIA, and subsequent deterioration. Lesser degrees of substantial acute recovery were also associated with greater risk of subsequent deterioration.

Conclusions— Patients with TIA may be a greater risk of subsequent neurological deterioration from causes other than hemorrhage. Substantial acute recovery may be an indicator of greater instability more broadly.

Key Words: cerebral ischemia, transient • classification • prognosis • recovery of function • stroke

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]

				E. E. Smith, A. R. Abdullah, I. Petkovska, E. Rosenthal, W. J. Koroshetz, and L. H. Schwamm Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke Stroke, November 1, 2005; 36(11): 2497 - 2499. [Abstract] [Full Text] [PDF]

				S. Aslanyan, C. J. Weir, S. C. Johnston, K. R. Lees, and for the GAIN International Steering Committee and Poststroke Neurological Improvement Within 7 Days Is Associated With Subsequent Deterioration Stroke, September 1, 2004; 35(9): 2165 - 2170. [Abstract] [Full Text] [PDF]