Transient ischemic attacks in younger and older patients. A comparative study of 798 patients in South Africa

The literature concerning transient ischemic attacks in young adults compared with strokes in young adults is scanty. This study evaluates the profile of transient ischemic attacks in young patients (aged 45 years or younger) compared with older patients (aged older than 45 years).

Between 1981 and 1991, 75 young patients (aged 45 years or younger) and 723 older patients (aged older than 45 years) were diagnosed as having a transient ischemic attack and included in the study. History of presenting transient ischemic attack, risk factors, clinical features, investigations, and etiology were compared on the basis of the above age groups.

In younger patients the presenting transient ischemic attack occurred less frequently in the vertebrobasilar territory (9% versus 21%, P = .03). Risk factor analysis revealed significant differences between the groups, with hypertension, previous smoking history, ischemic heart disease, and peripheral vascular disease being more common in the older group. Migraine and valvular heart disease were more common in the younger group. Approximately 60% of the patients in each group had multiple etiologies. The most common etiology was atheromatous cerebrovascular disease in both groups (74% versus 37% [P < .0001] in the older and younger groups, respectively). Other significant etiologic differences included fibromuscular dysplasia, mitral valve prolapse, and use of oral contraceptives occurring more frequently in the younger group, and ischemic heart disease occurring more frequently in the older group.

This study reveals the clinical and etiologic differences between younger and older patients with transient ischemic attack. The importance of multiple etiologies in both groups of patients has diagnostic and management implications.