A Case of Refractory Transient Ischemic Attack Successfully Managed with Chotosan

Abstract

We report a case of refractory transient ischemic attack (TIA) successfully treated with chotosan. A 64-year-old woman with recurrent right hemiparesis and dysarthria was seen in our clinic. Twenty-three months before coming to our clinic, she had a history of right hemiparesis and dysarthria, which resolved soon after treatment. Magnetic resonance imaging (MRI) revealed an ischemic legion in the left corona radiata. Then 4 months before coming, she had repeated transient right hemiparesis and dysarthria, which lasted for 40 to 50 minutes and recurred 3 to 4 times a week. She was hospitalized and treated with an intensive TIA therapy including direct thrombin inhibitor, dual antiplatelet therapy, statin, calcium channel blocker and benzodiazepine. Though she continued the therapy for 4 months, it proved ineffective. She was referred to our clinic, and we started to administer chotosan 7.5 g per day for anxiety and dizziness during an attack. Chotosan attenuated TIA within a week, but aggravated after discontinuation on her own. The medication was resumed and TIA diminished within three months. Chotosan treatment has now been continued for 17 months without a single TIA for 14 months. Multiple studies have shown the protective effect of chotosan against cerebrovascular diseases including cerebral infarction and TIA. Therefore, chotosan may be an effective prescription for refractory TIA.