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Clinical Analysis of 1003 Cases of Transient Ischemic Attack

Author: JuWeiNa
Tutor: YangZuo;WuJiang
School: Jilin University
Course: Clinical
Keywords: transient ischemic attack(TIA) cerebral atherosclerosis cerebral arteries stenosis ABCD~2 score prognosis
CLC: R743.31
Type: Master's thesis
Year: 2010
Downloads: 203
Quote: 5
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Abstract


Transient ischemic attack is believed to be the main controllable risk factor of the first ischemic stroke and one of the common emergency in neurology department. ABCD2 score is accepted by here and abroad as an method which can evaluate the risk of TIA patients quickly and accurately, but this method also has certain limitation. It just consider age, blood pressure, blood sugar, clinical symptoms and duration of symptoms in the multiple clinical characteristics and risk factors of TIA, but neglect other factors such as cerebral atherosclerosis and cerebral arteries stenosis. More and more scholars put forward that we should deeper recognize, research and summarizes the TIA related clinical characteristics and risk factors ,and provide theory basis for formulating more standard and more pointed individualized diagnosis strategy.This study do the retrospective analysis which based on 1003 patients which hospitalization in Jilin university No.1 hospital between January 2007 and March 2010, summarized the clinical characteristics and cerebral vascular condition of these patients, primary study the relationship between cerebral atherosclerosis, cerebral arteries stenosis and every kind of clinical factors, risk factors, 7d prognosis, ABCD2 score, discusses the directive significance of every related factors.Results: 1. There is about 40 percent of TIA patients with symptomatic cerebral arteries stenosis, in which male 77.2 percent and female 22.8 percent; among these patients, 60 percent is internal carotid artery system vascular stenosis, 9.5 percent is vertebral basilar system vascular stenosis and 30.5 percent is both internal carotid artery system and vertebral basilar system vascular stenosis. 2. In TIA patients whose both internal carotid artery system and vertebral basilar system vascular stenosis, male is 31.9 percent, and male is 25.6 percent, not statistically significant; over 60 years old patients is 51.3 percent, which is obvious higher than other age groups, and it is statistically significant; The patients with diabetes mellitus is 31.3 percent, which is obvious higher than only internal carotid artery system vascular stenosis with diabetes mellitus group or only vertebral basilar system vascular stenosis with diabetes mellitus group. 3. In the TIA patients with cerebral arteries stenosis, there is 62 percent of patients with hypertension. In the TIA patients without cerebral arteries stenosis, there is 37.9 percent of patients with hypertension. The comparation of these two groups is statistically significant. 4. Duration of symptoms is less than 1 hour in 75 percent of TIA patients, and there are 83 percent with cerebral arteries stenosis among these patients. Duration of symptoms is more than 1 hour in 25 percent of TIA patients, and there are 33 percent with cerebral arteries stenosis among these patients. 5. In the patients whose ABCD2 score is in high risk group, there is 70.59 percent with internal carotid artery system vascular stenosis, and there is none with vertebral basilar system vascular stenosis. The comparation of these two groups is statistically significant. 6. In all the patients who did the carotid ultrasound examination, there is 56.2 percent were discovered different level atherosclerotic evidence (IMT incrassation, plaque-forming, lumen stenosis and vascular blocking), and the most is plaque-forming, which is about 62.3 percent, obvious higher than IMT incrassation group, lumen stenosis group or vascular blocking group. 7. In the patients with athrosclersis, the separate proportion of the patients with hypertension, diabetes mellitus and elevation of LDL is 63.1 percent, 21.3 percent, and 24.3 percent. In the patients without athrosclersis, the separate proportion of the patients with hypertension, diabetes mellitus and elevation of LDL is 54.6 percent, 15.3 percent, and 17 percent. The comparation of these two groups is statistically significant. 8. In the patients whose ABCD2 score is in high risk group, there is 92.8 percent with athrosclerosis, 7.2 percent without athrosclerosis. The comparation of these two groups is statistically significant. 9. In the TIA patients with IMT incrassation, the proportion of these patients whose ABCD2 score is in high risk group is 5.4 percent; In the TIA patients with plaque-forming, the proportion of these patients whose ABCD2 score is in high risk group is 6.1 percent; In the TIA patients with lumen stenosis, the proportion of these patients whose ABCD2 score is in high risk group is 8.6 percent. The comparation of these three groups is statistically significant. 10. In the TIA patients with IMT incrassation, the proportion of these patients who is infarction in 7 days is 6.7 percent; In the TIA patients with plaque-forming, the proportion of these patients who is infarction in 7 days is 7.1 percent; In the TIA patients with lumen stenosis, the proportion of these patients who is infarction in 7 days is 9.3 percent. The comparation of these three groups is statistically significant.Conclusion:1. The relationship between cerebral arteries stenosis and TIA⑴The TIA patients with symptomatic cerebral arteries stenosis is 41 percent. Among these patients male is more than female, the morbidity of hypertension is higher than the patient group without cerebral arteries stenosis, and eld patients with diabetes mellitus are liable to happen far-ranging cerebral arteries stenosis(ont only one artery stenosis or both front and back circulation are put into trouble).⑵The TIA patients whose duration of symptoms is less than 1 hour always accompany with cerebral arteries stenosis. The TIA patients whose duration of symptoms is more than 1 hour always not accompany with cerebral arteries stenosis. The characteristic of TIA which is caused by cerebral arteries stenosis are temporary straitlaced and repeated.⑶The comparation of ABCD2 score between the patients with cerebral arteries stenosis and without cerebral arteries stenosis is not statistically significant, so there is no direct relationship between the risk of infarction in TIA patients and whether with cerebral arteries stenosis or not. Comparing the propotion that ABCD2 score is in high risk group between the TIA patients with front circulation vascular stenosis and the patients with back circulation vascular stenosis, the former is more than the later, and the former has the higher risk of infarction.2. The relationship between atherosclerotic plaque-forming and TIA⑴There is 56.2 percent of TIA patients with different level atherosclerotic plaque-forming. Among these patients, male is more than female, and the morbidity of hypertension, diabetes mellitus and elevation of LDL are obviously higher than the group without atherosclerotic plaque-forming, the most obvious is elevation of LDL.⑵The comparation of ABCD2 score between the patients with atherosclerotic plaque-forming and without atherosclerotic plaque-forming is statistically significant, so there is direct relationship between the risk of infarction in TIA patients and whether with atherosclerotic plaque-forming or not, and the risk of infarction in the former is relatively higher.⑶The degree of atherosclerosis influence the prognosis of TIA patients directly. With the atherosclerotic degree is more serious, the higher ABCD2 score is, the more the number of patients who is infarction.3. The clinical characteristic of the TIA patients who is infarction in 7 days and the TIA patients whose duration of symptoms is more than 60 minutes⑴TIA patients who is infarction in 7 days in this study show some characteristics:①majority is female;②always with hypertention, hypercholesterolemia and elevation of LDL;③can discover the atherosclerotic evidence in carotid ultrasound;④duration of symptoms is relative long, always more than 1 hour.⑵TIA patients whose duration of symptoms is more than 60 minutes in this study show some characteristics:①majority is female;②more is under 40 years old;③clinical symptoms are almost vertebral basilar system symptoms;④prognosis mala, infarction in short time.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Cerebrovascular disease > Acute cerebrovascular disease ( stroke) > Transient ischemic
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