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Orthostatic hypotension as a risk factor for symptomatic occlusive cerebrovascular disease
1Department of Neurology, University of California, Los Angeles.
Insights
Orthostatic hypotension (OH) can mimic transient ischemic attacks (TIAs) in patients with severe artery disease. Managing OH may prevent the need for invasive stroke prevention measures.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- Transient ischemic attacks (TIAs) are often linked to large artery disease.
- Orthostatic hypotension (OH) is a common condition in older adults and those with chronic diseases.
Observation:
- Thirteen patients experienced brief, repetitive TIAs associated with severe artery disease and impaired cerebral blood flow.
- These patients also had orthostatic hypotension (OH) linked to diabetes, aging, or cardiovascular treatments.
Findings:
- Medical management of OH resolved TIA symptoms in these patients.
- Treating OH reduced or eliminated the need for stroke prevention interventions like surgery or anticoagulation.
Implications:
- Focal cerebral hypoperfusion due to combined vascular disease and OH is a potentially underreported cause of TIAs.
- This suggests a treatable mechanism for certain TIA presentations, emphasizing the importance of assessing and managing OH.
Abstract:
Thirteen patients presented with brief, repetitive, stereotyped transient ischemic attacks, large artery atherostenoses or occlusions with impaired collateral flow to a cortical perfusion borderzone, and orthostatic hypotension (OH). OH was caused by diabetes mellitus, aging, and treatments for ischemic heart disease and hypertension. Medical management of OH often eliminated the need for stroke prevention measures such as surgery or anticoagulation. Focal cerebral hypoperfusion from the combination of occlusive vascular disease and OH may be an underreported, treatable cause of TIA and stroke.