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'Crescendo' transient ischemic attacks

Clinical and angiographic correlations

From the Departments of Neurosciences (Drs. Rothrock, Lyden, and Wiederholt) and Internal Medicine (Dr. Yee), University of California, San Diego Medical Center, San Diego, CA.

Forty-seven consecutive patients presenting acutely with repetitive symptoms indicative of anterior circulation ischemia ("crescendo" transient ischemic attacks) were evaluated to identify clinical features that might reliably predict the presence of significant stenosis, ulceration, or both in the presumably symptomatic internal carotid artery. Angiographic or intraoperative correlation was obtained in all patients, and 26 (55%) were found to have anatomically significant disease. Of 20 patients with signs or symptoms suggestive of cortical ischemia, amaurosis fugax, or both, 17 (85%) had "positive" angiograms; of 18 with numbness/weakness only, 9 (50%) had positive angiograms; of 9 whose symptoms suggested lacunar ischemia, none had positive angiograms.

Address correspondence and reprint requests to Dr. Rothrock, UCSD Stroke Program, 225 Dickinson Street, H815-A, San Diego, CA 92103.

Supported in part by a grant from the American Heart Association, San Diego Chapter.

Presented in part at the fifty-seventh Annual Scientific Sessions of the American Heart Association, Miami, FL, November 1984, and the Tenth Annual Joint Conference on Stroke and Cerebral Circulation, New Orleans, LA, February 1985.

Received February 3, 1987. Accepted for publication in final form April 23, 1987.

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