title: Should We Treat a Patient's Symptoms or Angiography Image in TIA?: Two Case Reports.
abstract: OBJECTIVE
  Data on vascular status in the first hours after onset of transient ischemic attack (TIA) and its clinical significance are missing. Also, it is not known whether arterial occlusion, if present in TIA, should be the target for revascularization. We present 2 patients to demonstrate that TIA can be due to acute major intracranial arterial occlusion and to show how such arterial occlusion may affect the outcome.
  
  
  METHODS
  Two patients (54 and 63 years old) were diagnosed with TIA and at the same time had occlusion of the middle cerebral artery. No recanalization therapy was performed, as there was no or minimal neurological deficit. After several hours, the condition of both patients clinically deteriorated. One patient experienced spontaneous recanalization in the first 24 hours and clinical improvement over the subsequent days, resulting in complete resolution of the neurological deficit. The other patient did not recanalize and developed a significant brain infarction as well as hemorrhagic transformation requiring decompression surgery. Over the long term, the patient remained hemiplegic, unable to walk, and dependent on assistance for most activities of daily living.
  
  
  CONCLUSIONS
  The cases presented here raise important questions: (1) How frequently is arterial occlusion present in clinically asymptomatic patients? (2) If occlusion is present but not symptoms, is stroke a more correct diagnosis than TIA? and (3) What would be the benefit of recanalization therapy? Studies addressing these questions should be conducted.
authors: *International Clinical Research Center, Department of Neurology, St. Anne's University Hospital Brno, Brno †Faculty of Medicine, Masaryk University Brno, Brno ‡Department of Neurology, Hospital Blansko, Blansko, Czech Republic.
authors: Hana
authors: H
authors: Karpatová
authors: Jana
authors: J
authors: Jankových
authors: Robert
authors: R
authors: Mikulík
mesh_terms: D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D018450:Disease Progression; D005260:Female; D006429:Hemiplegia; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D008875:Middle Aged; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed