The clinical features and the recovery process in patients with ischemic stroke with transient ischemic attacks in the past

Abstract

Introduction: According to WHO, the global mortality from ischemic stroke is 9% annually, representing the third cause of death after heart diseases and cancer. The stroke is the main determinant of physical and mental disabilities in adults. The incidence and prevalence of transient ischemic attacks (TIAs) are continuously increasing due to the aging of the population worldwide. The importance of rapid and accurate diagnosis of TIAs is based on the fact that after a first TIA approximately 5% of patients develop a stroke during the next two days and about 20-30% - over the next 90 days. TIAs are important predictive factors of future stroke. The effective treatment of TIAs can prevent the recurrence of cerebral infarction. Recent studies show that the TIAs in the history of patients presenting an actual stroke can stimulate the cerebral resistance, like a neuroprotective factor. Purpose and objectives: The clinical research of the evolution and recovery process in patients with ischemic stroke with TIAs in the past; the analysis of literature medical data on the importance of TIAs in the development and evolution of strokes; the stroke evolution assessment in patients with TIAs in the past during the acute, early and late recovery phases. Materials and methods: The study was conducted on 33 patients with ischemic stroke, the acute, early and late recovery phases, with and without TIAs in the past, and included: clinical examination of the patients (general clinical examination, neurological examination, history disease, underlining the presence of TIAs in the past); assessment of functional independence degree after stroke, using the Barthel score; statistical evaluation of data obtained by comparative analysis and graphics. Results: In the present study was determinate that TIAs were present in 12 (36,4%) from 33 patients with ischemic stroke, at different intervals before the current stroke (from 2 week to 24 months). According to Barthel score, the average score obtained in examined patients was 37,8 points. The average score in patients with ischemic stroke without TIA in the past (21 patients - 63,3%) was 31,9 points, significantly lower than in the patients with stroke and TIA (12 patients- 36,4%), who accumulated, on average, 46,04 points. We also analyzed the functional independence degree depending on the time of ischemic stroke occurrence and the Barthel score achievement. In this case, the highest score was obtained in patients evaluated during the early post-stroke recovery (at 4-6 moths distance from the ischemic stroke) with 52,5 points, which can be explained by the presence of TIAs in the past of 2 patients from this subgroup and who accumulate a high Barthel score - 72,5 points. Conclusions: TIAs can be considerate as factors that induce cerebral ischemic preconditioning. The assessment of disability degree in patients with ischemic stroke using the Barthel score showed a significantly higher mean score in patients with stroke and TLA than in patients without TIA in the past. The highest Barthel score was obtained in patients evaluated in the early recovery period and in patients with TLA at 12 months before stroke.