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[A case of transient ischemic attacks preceded by postprandial hypotension]
K Obayashi1, K Kimura, Y Hashimoto
1Department of Cerebrovascular Disease, Kumamoto University School of Medicine.
Rinsho Shinkeigaku = Clinical Neurology
|September 1, 1995
Summary
This study presents a case of recurrent transient ischemic attacks (TIAs) in an elderly man, likely caused by autonomic dysfunction and carotid artery atherosclerosis leading to postprandial hypotension.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- A 78-year-old male patient with a history of total gastrectomy, myocardial infarction, and hypertension presented with recurrent neurological symptoms.
- Symptoms included transient loss of consciousness, aphasia, and right hemiparesis, occurring postprandially.
Observation:
- Attacks occurred 1-3 times daily, 30-60 minutes after meals, lasting 120-180 minutes.
- During attacks, blood pressure decreased, but pulse rate remained stable.
- Cerebral angiography revealed atherosclerotic occlusion of the left internal carotid artery.
- Myocardial uptake of 123I-metaiodobenzylguanidine (MIBG) was absent, suggesting autonomic dysfunction.
Findings:
- Duplex carotid ultrasonography showed a ~30% fall in blood flow velocity during attacks.
- The patient exhibited evidence of autonomic dysfunction and significant carotid artery atherosclerosis.
Implications:
- The findings suggest a hemodynamic transient ischemic attack (TIA) triggered by postprandial hypotension.
- This case highlights the complex interplay between autonomic dysfunction, major artery occlusion, and cerebrovascular events.