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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Ischemic Stroke l: Introduction01:15

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Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
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An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
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A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
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Related Experiment Video

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Quantification of Neurovascular Protection Following Repetitive Hypoxic Preconditioning and Transient Middle Cerebral Artery Occlusion in Mice
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Short- and Long-Term Prognoses After Tissue-Negative Transient Ischemic Attack.

Francisco Purroy1,2, Yhovany Gallego1,2, M Pilar Gil-Villar1,2

  • 1Department of Neurology (F.P., Y.G., M.P.G.-V., A.Q., J.S., D.V.-J., G.M.), Stroke Unit, Hospital Universitari Arnau de Vilanova de Lleida, Spain.

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Summary

Patients with negative diffusion-weighted imaging (DWI) transient ischemic attacks (TIA) face significant stroke recurrence risk. Optimized secondary prevention is crucial, as early and late stroke predictors differ.

Keywords:
etiologyischemic attack, transientprognosiswhite matter hyperintensities

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Medical Imaging

Background:

  • The clinical definition of transient ischemic attack (TIA) using diffusion-weighted imaging (DWI) has practical limitations.
  • Limited evidence exists on stroke risk and predictors in DWI-negative TIA patients.
  • This study addresses the prognosis of DWI-negative TIA patients presenting to emergency departments.

Purpose of the Study:

  • To evaluate the early and long-term prognosis of patients with DWI-negative TIAs.
  • To identify predictors of stroke recurrence in this patient group.
  • To inform secondary prevention strategies for DWI-negative TIA patients.

Main Methods:

  • Prospective cohort study of neurologist-confirmed, DWI-negative TIA patients.
  • DWI performed within 4 days of the index event.
  • Stroke recurrence (SR) assessed at 1 year and long-term (median 6.6 years).

Main Results:

  • 370 patients included; 15 (4.1%) experienced 1-year SR, 18 (4.9%) experienced SR beyond 1 year.
  • Large artery atherosclerosis predicted 1-year SR.
  • Male sex, speech impairment, and chronic microangiopathy (Fazekas score 3) predicted long-term SR.

Conclusions:

  • DWI-negative TIA patients have a significant risk of recurrent vascular events.
  • Optimized secondary prevention is warranted for these patients.
  • Stroke recurrence predictors vary between early and long-term follow-up periods.