Population-based study of capsular warning syndrome and prognosis after early recurrent TIA
Citation Manager Formats
Make Comment
See Comments
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objective: Many guidelines recommend emergency assessment for patients with ≥2 TIAs within 7 days, perhaps in recognition of the capsular warning syndrome. However, it is unclear whether all patients with multiple TIAs are at high early risk of stroke and whether treatable underlying pathologies are more prevalent in this group.
Methods: We studied clinical characteristics, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and risk of stroke in 1,000 consecutive patients with incident and recurrent TIAs in a prospective, population-based study (Oxford Vascular Study).
Results: Of 1,000 patients with TIAs, 170 had a further TIA within 7 days (105 within 24 hours). Multiple TIAs were not associated with carotid stenosis or atrial fibrillation, and much of the 10.6 (95% confidence interval [CI] 6.5−15.9) risk of stroke during the 7 days after the first TIA was due to patients with small-vessel disease (SVD) etiology (10 of 24 vs 8 of 146, odds ratio [OR] = 12.3, 95% CI 3.7–41.9, p < 0.0001), particularly those with motor weakness (i.e., capsular warning syndrome) compared with hemisensory events (9 of 15 [60%], 95% CI 35.3–84.7 vs 1 of 9 [11.1%], 95% CI 0–31.7, p = 0.03). The 7-day risk of stroke after a recurrent TIA was similar to the risk after a single TIA in patients with non-SVD TIA (8 of 146 [5.5%] vs 76 of 830 [9.2%], OR = 0.58, 95% CI 0.25–1.3, p = 0.20). Of the 9 patients with stroke after a capsular warning syndrome, all had the recurrent TIA within 24 hours after the first TIA, and the subsequent stroke occurred within 72 hours of the second TIA in 8. The ABCD2 scores of all preceding TIAs were ≥4 in all 9 patients with capsular warning syndrome before stroke.
Conclusions: Capsular warning syndrome is rare (1.5% of TIA presentations) but has a poor prognosis (7-day stroke risk of 60%). Otherwise, recurrent TIA within 7 days is not associated with a greater stroke risk than that after a single TIA.
GLOSSARY
- CI =
- confidence interval;
- GP =
- general practitioner;
- OR =
- odds ratio;
- OXVASC =
- Oxford Vascular Study;
- SVD =
- small-vessel disease;
- TOAST =
- Trial of Org 10172 in Acute Stroke Treatment
Footnotes
Study funding: The Oxford Vascular Study is funded by the UK Medical Research Council, Dunhill Medical Trust, Stroke Association, BUPA Foundation, National Institute for Health Research (NIHR), Thames Valley Primary Care Research Partnership, NIHR Biomedical Research Centre, Oxford, and the Wellcome Trust.
- Received December 29, 2011.
- Accepted May 8, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
More Online
Dr. Dennis Bourdette and Dr. Lindsey Wooliscroft
► Watch
Topics Discussed
Alert Me
Recommended articles
-
Article
Prospective observational cohort study of early recurrent TIAFeatures, frequency, and outcomeMatteo Foschi, Lucia Pavolucci, Francesca Rondelli et al.Neurology, July 29, 2020 -
Article
Total small vessel disease score and risk of recurrent strokeValidation in 2 large cohortsKui Kai Lau, Linxin Li, Ursula Schulz et al.Neurology, May 17, 2017 -
Article
Effect of coexisting vascular disease on long-term risk of recurrent events after TIA or strokeMarion Boulanger, Linxin Li, Shane Lyons et al.Neurology, July 23, 2019 -
Article
Five-Year Prognosis After TIA or Minor Ischemic Stroke in Asian and Non-Asian PopulationsTakao Hoshino, Shinichiro Uchiyama, Lawrence K.S. Wong et al.Neurology, October 12, 2020