title: Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke.
abstract: OBJECTIVE
  The aim of our study was to identify factors associated with stroke recurrence after an initial minor stroke or transient ischemic attack (TIA) in a prospective hospital-series.
  
  
  METHODS
  Included in the series were 689 patients with NIHSS lower than 4 at hospital admission. The end point was a new neurological event (worsening >/=4 points in the initial NIHSS was considered as recurrence) at 90 days (and additionally at 7 days). Factors based on two previous reported scores (ABCD and SPI-II) were analyzed in relation with stroke recurrence: age, duration of symptoms >1 hour, weakness, speech impairment, initial hypertension, hypertension, diabetes, coronary disease, minor stroke versus TIA, prior stroke, and heart failure. We also analyzed: gender, hyperlipidemia, severe alcohol intake (>60gr/d), current smoking habits, peripheral arterial disease, atrial fibrillation, acute lesion in initial head computed tomography, severe symptomatic extra or intracranial arterial disease (SSAD; arterial stenosis >/=70%), previous TIA, and vertebrobasilar event. Patients were also analyzed separately according to diagnosis of TIA or minor stroke.
  
  
  RESULTS
  90-day recurrence occurred in 111 patients (16.1%), whereas 62 patients had 7-day recurrence (9%). The independent variables associated with 90-day recurrence were: SSAD (OR=4.97), weakness (OR=3.25), speech impairment (OR=1.96), severe alcohol intake (OR=4.18), heart failure (OR=2.41), previous TIA (OR=4.62), and vertebrobasilar events (OR=2.87). SSAD was independently associated with 7-day recurrence (OR=7.73) and also for TIA (OR=3.45) and minor stroke (OR=5.15) patients.
  
  
  CONCLUSIONS
  An arterial study to discard SSAD would be necessary, in combination with clinical factors, to improve the identification of patients with a higher risk of 90-day recurrence after an initial minor stroke or TIA.
authors: Servicio de Neurología, Hospital del Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain. 94545@imas.imim.es
authors: Angel
authors: A
authors: Ois
authors: Meritxell
authors: M
authors: Gomis
authors: Ana
authors: A
authors: Rodríguez-Campello
authors: Elisa
authors: E
authors: Cuadrado-Godia
authors: Jordi
authors: J
authors: Jiménez-Conde
authors: Claustre
authors: C
authors: Pont-Sunyer
authors: Gracia
authors: G
authors: Cuccurella
authors: Jaume
authors: J
authors: Roquer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology; D001037:Aphasia / Q000453:epidemiology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000453:epidemiology