Abstract
A 62-year-old man was admitted to our hospital because of repeated TIA presenting with vertigo, diplopia and perioral numbness. He had a history of brain stem infarction with an occlusion of the left vertbral artery four years prior to the prsent attacks, and had been receiving antiplatelet agent since then. He was hypertensive (178/100 mmHg) and obese, and appeared to be anemic. After admission, a gastroscopic examination revealed the presence of multiple erosive polyps of the stomach which was thought to be the cause of severe iron deficiency anemia (hemoglobin : 7.2 g/dl). Severe stenosis of the right vertebral artery was also demonstrated by right brachial angiography. During admission, TIA recurred frequently when blood hemoglobin decreased below 9.0 g/dl or hematocrit below 30%. Ater polypectomy, TIA ceased to occur accompanied by the recovery of anemia even without using antiplatelet agent.
In reviewing the clinical course of this patient, it is evident that the prsence of severe anemia accelerated the occurrence of hemodynamic TIA because of reduced oxygen transport capacity of the blood. For management of TIA, careful observation of underlying medical disorders is important as well as the exploration of vascular diseases.
