Abstract
We report two cases with clustering of TIAs, i.e. crescendo TIA, who developed into cerebral infarction within a few days after the initial TIA attack. Case 1 was a man of 56 years of age with hypertension, and case 2 was a woman of 42 years of age with hypertension and diabetes mellitus. The former patient suffered from transient pure motor hemiparesis (face, upper and lower limb) 6 times during a period of 3 days, and the latter patient from transient sensorimotor stroke (face, upper and lower limb) 8 times during 3 days. Both developed into lacunar infarction in the territory of the cerebral basal ganglia despite intensive therapies including heparin administration. Neither case had cardiac arrythmia, cardiac diseases, blood coagulopathy, of cerebrovascular lesions. The mechanism of TIA in our cases was strongly considered to be in-situ small perforating vessel disease, such as lipohyalinosis. It is suggested that crescendo TIA, where the neurologic manifestation is lacunar syndrome and the mechanism can be explained by perforator lesions, is resistant to various kinds of preventive procedures and shows a poor prognosis, resulting in cerebral infarction within a short period. We discuss the particular characteristics of this type of TIA in relation to the literature.
