Predictors of cerebral infarction following transient ischemic attack

Transient ischemic attack (TIA) is a warning sign for impending cerebral infarction, mainly within several months following the attack. To determine if any clinical characteristics could prognosticate cerebral infarction following a TIA, we studied and followed 68 consecutive patients who presented with a TIA. We determined the vascular risk factors, frequency, duration, vascular territory involved, and presumed etiology of the attacks. Diagnostic tests and treatment were individualized. Follow-up ranged from 1 day to 36 months (mean, 19 months). Four patients died from non-neurologic causes without having had a stroke. Cerebral infarction occurred in five patients (7%), 6 hours, 1 day, 10 days, 5 months, and 14 months after the presenting TIA. Two clinical characteristics were associated with a significantly increased risk of cerebral infarction: diabetes mellitus (p < 0.001) and history of multiple TIAs > 1/month at the time of presentation (p = 0.005). Patients presenting with a recent TIA and these risk factors may benefit from more aggressive treatment.