Abstract
We investigated the characteristic clinical findings of so-called crescendo TIA in relation to the etiology of TIA. Forty-eight patients who underwent cerebral angiography were divided into the following 5 groups according to the etiology of TIA : a perforator lesion group (P group), microembolism group (M group), cerebrovascular insufficiency group (I group), cardiogenic embolism group (E group), and unknown group. The following definition of crescendo TIA was adopted; TIA attack which repeated 3 or more times within 72 hours before evaluation, or which repeated 2 or more times within 24 hours after evaluation. The number of patients in each group was 17 (35%) in the P group, 15 (31%) in the M, 5 (10%) in the I, 5 (10%) in the E, and 6 (13%) in the unknown group. Among all TIA cases, the number with crescendo TIA was only 7 (14%), comprising 6 cases of the P group (35% of 17 cases in the P group) and 1 case of the M group (7% of 15 cases in the M group). There was no definite difference in clinical picture between the crescendo and non-crescendo cases of the P group. However the occurrence rate of cerebral infarction (%/person month) in the P group was higher in the crescendo cases than in the non-crescendo cases, i.e. 1.6 vs 0.6. Moreover, the cerebral infarction observed in the crescendo cases occurred within 3 days after the initial TIA attack despite the application of intensive drug therapies including heparin administration. Cerebral infarction was, in contrast, not experienced in the crescendo case of the M group. The present data suggest that crescendo TIA in Japan is rare, and is liable to be observed in TIA cases, whose etiology can be explained by perforator lesions, such as lipohyalinosis. Cases of crescendo TIA belonging to the P group are also liable to develop into cerebral infarction soon after the initial TIA attack.
