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Updated: Oct 18, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Attack Interval Is the Key to the Likely Pathogenesis of Multiple Transient Ischemic Attacks
Yoshinari Nagakane1, Tomoyuki Ohara1, Eijirou Tanaka1
1Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Introduction:
The aim of this study was to test the hypothesis that the attack interval of multiple transient ischemic attacks (TIAs) is correlated with the underlying pathogenesis of ischemia.
Methods:
Patients with multiple TIAs, defined as 2 or more motor deficits within 7 days, were studied. The attack interval between the last 2 episodes was classified into 3 groups: 2 episodes within an hour (Hour group), over hours within a day (Day group), and over days within a week (Week group). Patients with a lacunar syndrome, no cortical lesions, and no embolic sources were recognized as having a small vessel disease (SVD) etiology for their multiple events.
Results:
Of 312 TIA patients admitted over a 9-year period, 50 (37 males, 13 females, mean 67.6 years) had multiple TIAs. Twelve patients were classified as being within the Hour group, 23 within the Day group, and 15 within the Week group. Lacunar syndromes were observed in 30 (75%, 35%, and 67%), embolic sources were detected in 28 (25%, 65%, and 67%), and a high signal lesion on diffusion-weighted imaging was depicted in 30 (75%, 48%, and 67%) patients (18 cortical, 11 subcortical, and one cerebellar). Patients in the Hour group had a significantly higher prevalence of SVD etiology (75%) than those in the Day and Week groups (30%, p = 0.0165; 27%, p = 0.0213, respectively). Four patients had a subsequent stroke within 7 days.
Conclusion:
Attack intervals of multiple TIAs may be correlated with the underlying pathogenesis of ischemia. Two motor deficits within an hour are more likely to suggest a SVD etiology.
Insights
The timing of multiple transient ischemic attacks (TIAs) may indicate the cause of ischemia. Experiencing two TIAs within an hour suggests a small vessel disease (SVD) etiology.
Area of Science:
- Neurology
- Vascular Neurology
- Ischemic Stroke Research
Background:
- Multiple transient ischemic attacks (TIAs) are a critical warning sign for stroke.
- Understanding the underlying causes of TIAs is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate the correlation between the time interval of multiple TIAs and their underlying ischemic pathogenesis.
- To determine if specific attack intervals are indicative of particular causes of ischemia.
Main Methods:
- A cohort of 50 patients with multiple TIAs (≥2 motor deficits within 7 days) was analyzed.
- TIAs were categorized into three groups based on the interval between the last two episodes: within an hour, within a day, or within a week.
- Patients were assessed for lacunar syndromes, cortical lesions, embolic sources, and diffusion-weighted imaging findings to determine etiology, particularly small vessel disease (SVD).
Main Results:
- Patients experiencing two TIAs within an hour showed a significantly higher prevalence of SVD etiology (75%) compared to those with longer intervals (30-27%).
- Lacunar syndromes were prevalent across groups, but more so in the 'Hour' group.
- A small percentage of patients (4) experienced a subsequent stroke within 7 days.
Conclusions:
- The interval between multiple TIAs appears to be associated with the underlying cause of ischemia.
- An attack interval of two motor deficits within one hour is a strong indicator of small vessel disease (SVD) as the etiology.
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