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Cerebrovascular disease

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Diagnostic Tests in Neurology

Part of the book series: Diagnostic Tests Series ((DTS))

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Abstract

Initial classification of cerebrovascular events continues to be a clinical one based on the duration of symptomatology. Transient ischaemic attacks (TIAs) are events, thought to be based on ischaemia, which last for less than 24 hours. In reality, the majority of attacks last for a much shorter period. In one study, the median duration of carotid attacks was 14 min, and, for vertebrobasilar attacks, 8 min. For the former, 90% remitted within 6 h, for the latter, 90% remitted within 2 h[1]. Attacks exceeding 24 h in duration, but remitting in 3–4 days have been described as reversible ischaemic neurological deficits (RIND). Evidence indicates that these events, and, indeed, longer-lasting TIAs, are commonly associated with cerebral infarction, as defined by CT scanning. Indeed, the assumptions that TIAs are necessarily related to ischaemia, and unassociated with permanent structural change can be questioned. In one study of 22 patients with TIA, CT detected focal abnormalities in 32%, and MRI in 77% [2]. In another analysis comparing TIA, RIND and stroke with minimal residuum, focal ischaemic lesions, detected by CT scanning were found in 25, 25 and 35% of patients respectively [3]. Rapid recovery of neurological function, therefore, can coexist with permanent structural change as defined by CT or MRI. Many conditions, some unrelated to ischaemia, can present as TIA, including epilepsy and hypoglycaemia [4]. Similar variability, in terms of pathogenesis, is encountered in patients whose clinical presentation suggests a stroke. In an analysis of 821 patients admitted to an acute stroke unit, 13% proved to have other diagnoses, most commonly seizures, confusional states or syncope [5]. Others have claimed a higher clinical acumen, with pre- and post-CT diagnosis of stroke in agreement in 96% of cases [6]. There is universal agreement, however, that the distinction of cerebral infarction from haemorrhage based on clinical critera alone, is fraught with error. If CT scanning is used as the final arbiter, it is evident that about a quarter of all cerebral haemorrhages would have been diagnosed as infarcts if clinical criteria alone had been used [7]. In a recent population survey, where 89% of 168 strokes had had either autopsy or CT scanning, cerebral infarction was found in 76%, cerebral haemorrhage (including subarachnoid haemorrhage) in 13%, whilst 11% remained unclassified [8].

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    G. D. Perkin

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Perkin, G.D. (1988). Cerebrovascular disease. In: Diagnostic Tests in Neurology. Diagnostic Tests Series. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3320-1_3

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