Differentiating transient ischemic attacks from stroke mimics with radio-imaging and angiography

Abstract

Background: Physicians resistance for radio imaging pose problems differentiating transient ischemic strokes (TIA) from Stroke Mimics (SM). Secondly in hypertensive patients, its progressive- type and severity are ignored. Objective: 1) Differentiating TIAs from SM with neuro radio imaging and understanding hypertensive behavior. Materials and Methods: Forty five hypertensive patients with an ‘initial-diagnosis’ of TIAs were studied retrospectively between year 2008 and 2012. DW- MR radio-imaging and carotid-Digital Subtraction Angiography (DSA) differentiated SM from TIAs for the final diagnosis. Results: Eight patients of TIAs and one with amaurosis-fugax (AF) included in group 1 category. Radio-imaging showed focal-parenchymal and paraventricular edema in TIAs. AF was due to transient retinal ischemia. The remaining 80% diagnosed as stroke- mimics. These are divided in Group 2-Thirty patients, 66.66% with varied oetiology and Group 3 –Six patients (13.33%) had a final diagnosis of psychosomatic- transient loss of consciousness (P-TLC). Conclusion: Hypertension history over past eighteen months showed Increasingly-Changing Hypertension (ICh-P) in all stenotic -TIAs cases. Average age for TIAs’ in hypertensive males found was 59 years and in hypertensive females 67 years. CAS and hypertension collectively showed long history with 20% incidence of stenotic -TIAs. Incidence of stroke mimics was 80% with mild hypertension.