Transient ischemic attack before nonlacunar ischemic stroke in the elderly.
BACKGROUND
Several studies suggest transient ischemic attack (TIA) may be neuroprotective against ischemic stroke analogous to preinfarction angina's protection against acute myocardial infarction. However, this protective ischemic preconditioning-like effect may not be present in all ages, especially among the elderly. The purpose of this study was to determine the neuroprotective effect of TIAs (clinical equivalent of cerebral ischemic preconditioning) to neurologic damage after cerebral ischemic injury in patients over 65 years of age.


METHODS
We reviewed the medical charts of patients with ischemic stroke for presence of TIAs within 72 hours before stroke onset. Stroke severity was evaluated by the National Institutes of Health Stroke Scale and disability by a modified Rankin scale.


RESULTS
We evaluated 203 patients (>or=65 years) with diagnosis of acute ischemic stroke and categorized them according to the presence (n = 42, 21%) or absence (n = 161, 79%) of TIAs within 72 hours of stroke onset. Patients were monitored until discharged from the hospital (length of hospital stay 14.5 +/- 4.8 days). No significant differences in the National Institutes of Health Stroke Scale and modified Rankin scale scores were observed between those patients with TIAs and those without TIAs present before stroke onset at admission or discharge.


CONCLUSIONS
These results suggest that the neuroprotective mechanism of cerebral ischemic preconditioning may not be present or functional in the elderly.
Della Morte
David
D
Department of Internal Medicine, Cardiovascular Sciences, and Immunology, University Federico II, Naples, Italy. DMorte@med.miami.edu
Abete
Pasquale
P
Gallucci
Ferdinando
F
Scaglione
Anna
A
D'Ambrosio
Daniele
D
Gargiulo
Gaetano
G
De Rosa
Giovanna
G
Dave
Kunjan R
KR
Lin
Hung Wen
HW
Cacciatore
Francesco
F
Mazzella
Francesca
F
Uomo
Generoso
G
Rundek
Tanja
T
Perez-Pinzon
Miguel A
MA
Rengo
Franco
F