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Vol. 22, No. 1, 2006
Issue release date: June 2006
Cerebrovasc Dis 2006;22:27–32

Delayed Transient Worsening of Neurological Deficits after Ischaemic Stroke

De Reuck J. · De Groote L. · Van Maele G.
Departments of aNeurology and bMedical Statistics, Stroke Unit, Ghent University Hospital, Ghent, Belgium

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Background: Although the causes of stroke recurrence are well known, no particular study deals with the specific issue of late-onset transient worsening of the neurological deficit (TWND) after an ischaemic stroke. Patients and Methods: In this retrospective study the aetiology of the TWNDs in 101 patients was compared to the causes of transient ischaemic attacks (TIAs) in 115 patients. All patients had a full cardiovascular and neuroimaging examination according to current guidelines. An electroencephalogram (EEG) was performed when necessary. The diagnosis of inhibitory seizures was retained when the EEG showed periodic lateralized epileptiform discharges or intermittent rhythmic delta activities, or when the patient developed typical seizures afterwards. Results: Arterial hypertension and diabetes were more prevalent vascular risk factors in TWND patients. Small-vessel disease and inhibitory seizures were a more frequent cause of TWNDs than of TIAs. Extracranial large-vessel disease predominates in TIA patients. The global prevalence of cardiac diseases as cause of TIAs and TWNDs was the same, although severe ulcerous plaques of the aortic arch and patent foramen ovale with atrial septum aneurysm occurred more frequently in TWND patients. Conclusions: The most frequent causes of late-onset TWNDs were different from those of TIAs. Apart from repeated neuroimaging of the brain, exhaustive cardiac investigations and EEG are mandatory in TWND patients.

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  1. Wilterdink JL, Easton JD: Vascular event rates in patients with atherosclerotic cerebrovascular disease. Arch Neurol 1992;49:857–863.
  2. Clark TG, Murphy MF, Rothwell PM: Long term risks of stroke, myocardial infarction, and vascular death in ‘low risk’ patients with a non-recent transient ischaemic attack. J Neurol Neurosurg Psychiatry 2003;74:577–580.
  3. Hardie K, Hankey GJ, Jamrozik K, Broadhurst RJ, Anderson C: Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study. Stroke 2004;35:731–735.
  4. Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP: The high risk of stroke immediately after transient ischemic attack: a population-based study. Neurology 2004;62:2015–2120.
  5. Kimura K, Minematsu K, Kazui S, Yamaguchi T, Japan Multicenter Stroke Investigation’s Collaboration (J-MUSIC): Mortality and cause of death after hospital discharge in 10,981 patients with ischemic stroke and transient ischemic attack. Cerebrovasc Dis 2005;19:171–178.
  6. van Wijk I, Kappelle LJ, van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, Gorter JW, Algra A, LiLAC study group: Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet 2005;365:2098–2104.
  7. Brown DL, Lisabeth LD, Roychoudhury C, Ye Y, Morgenstern LB: Recurrent stroke risk is higher than cardiac event risk after initial stroke/transient ischemic attack. Stroke 2005;36:1285–1287.
  8. Hornig CR, Lammers C, Buttner T, Hoffmann O, Dorndorf W: Long-term prognosis of infratentorial transient ischemic attacks and minor strokes. Stroke 1992;23:199–204.
  9. Flossmann E, Rothwell PM: Prognosis of vertebrobasilar transient attack and minor stroke. Brain 2003;126:1940–1954.
  10. Evans BA, Sicks JD, Whisnant JP: Factors affecting survival and occurrence of stroke in patients with transient ischemic attacks. Mayo Clin Proc 1994;69:416–421.
  11. Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, Stewart-Wynne EG: Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke 1998;29:2491–2500.
  12. De Reuck J, Helleputte T, De Burck E: Transient ischaemic attack. Patient Care 2005;28:27–29.
  13. Evans GW, Howard G, Murros KE, Rose LA, Toole JF: Cerebral infarction verified by cranial computed tomography and prognosis for survival following transient ischemic attack. Stroke 1991;22:431–436.
  14. Garcia-Morales I, Garcia MT, Galan-Davila L, Gomez-Escalonilla C, Saiz-Diaz R, Martinez-Salio A, de la Pena P, Tejerina JA: Periodic lateralized epileptiform discharges: etiology, clinical aspects, seizures, and evolution in 130 patients. J Clin Neurophysiol 2002;19:172–177.
  15. Baykan B, Kinay D, Gokygit A, Gurses C: Periodic lateralized epileptiform discharges: association with seizures. Seizure 2000;9:402–406.
  16. Kaplan PW: Gaze deviation from contralateral pseudoperiodic lateralized epileptiform discharges (PLEDs). Epilepsia 2005;46:977–999.
  17. Goldstein LB, Bertels C, Davis JN: Interrater reliability of the NIH Stroke Scale. Arch Neurol 1989;46:660–662.
  18. de Haan R, Horn J, Limburg M, Van Der Meulen J, Bossuyt PA: Comparison of five stroke scales with measures of disability, handicap and quality of live. Stroke 1993;24:1178–1181.
  19. Park AE, McCarthy WJ, Pearce WH, Matsumura JS, Yao JS: Carotid plaque morphology correlates with presenting symptomatology. J Vasc Surg 1998;27:872–878.
  20. Spagnoli LG, Mauriello A, Sangiorgi G, Fratoni S, Bonanno E, Schwartz RS, Piepgras DG, Pistolese R, Ippoliti A, Holmes DR Jr: Extracranial thrombotically active plaque as a risk factor for ischemic stroke. JAMA 2004;292:1845–1852.
  21. Stapf C, Elkind MS, Mohr JP: Carotid artery dissection. Annu Rev Med 2000;51:329–347.
  22. Leys D, Moulin T, Stoikovic T, Begey S, Chavot D, and the DONALD investigators: Follow-up of patients with history of cervical dissection. Cerebrovasc Dis 1995;5:43–49.

    External Resources

  23. Touze E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL: Multicenter Survey on Natural History of Cervical Artery Dissection. Risk of stroke and recurrent dissection after cervical artery dissection: a multicenter study. Neurology 2003;61:1347–1351.
  24. Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG: Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Eng J Med 1994;331:1474–1479.
  25. Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J, Patent Foramen Ovale and Atrial Septal Aneurysm Study Group: Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001;345:1740–1746.
  26. Sibon I, Orgogozo JM: Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology 2004;62:1187–1189.
  27. Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J: Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol 2005;62:1217–1220.
  28. Schmidt R, Fazekas F, Enzinger C, Ropele S, Kapeller S, Schmidt H: Risk factor and progression of small vessel disease-related cerebral abnormalities. J Neural Transm Suppl 2002;62:47–52.

    External Resources

  29. Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, Licata G: Cerebrovascular risk factors and clinical classification of strokes. Sem Vasc Med 2004;4:287–303.

    External Resources

  30. Hankey GJ: Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 2003;16(suppl 1):14–19.
  31. Kappelle LJ, van Latum JC, Koudstaal PJ, van Gijn J: Transient ischaemic attacks and small-vessel disease. Dutch TIA Study Group. Lancet 1991;337:339–341.
  32. Steinke W, Ley SC: Lacunar stroke is the major cause of progressive motor deficits. Stroke 2002;33:1510–1516.
  33. De Reuck J, Hemelsoet D, Nieuwenhuis L, Van Maele G: Computed tomographic changes in lacunar syndromes. Clin Neurol Neurosurg 2005;108:18–24.
  34. Rogers PN, Goldberg JA, Reid E, Carter R, Quin RO: Outcome of TIAs of unknown aetiology following non-invasive evaluation. Eur J Vasc Surg 1989;3:107–111.
  35. Globus M, Lavi E, Fich A, Abramsky O: Ictal hemiparesis. Eur Neurol 1982;21:165–168.
  36. Abou-Khalil B, Fakhoury T, Jennings M, Moots P, Warner J, Kessler RM: Inhibitory motor seizures: correlation with centroparietal structural and functional abnormalities. Acta Neurol Scand 1995;91:103–108.
  37. Armon C, Radtke RA, Friedman AH: Inhibitory simple partial (non-convulsive) status epilepticus after intracranial surgery. J Neurol Neurosurg Psychiatry 2000;69:18–24.
  38. Satow T, Ikeda A, Yamamoto J, Takayama M, Matsuhashi M, Ohara S, Matsumoto R, Begum R, Fukuyama H, Hashimoto N, Shibasaki H: Partial epilepsy manifesting atonic seizure: report of two cases. Epilepsia 2002;43:1425–1432.
  39. Meador KJ, Moser E: Negative seizures. J Int Neuropsychol Soc 2000;6:731–733.
  40. Grand’Maison F, Reiher J, Lebel ML, Rivest J: Transient anosognosia for episodic hemiparesis: a singular manifestation of TIAs and epileptic seizures. Can J Neurol Sci 1989;16:203–205.
  41. Lee H, Lerner A: Transient inhibitory seizures mimicking crescendo TIAs. Neurology 1990;40:165–166.
  42. Kaplan PW: Focal seizures resembling transient ischemic attacks due to subclinical ischemia. Cerebrovasc Dis 1993;3:241–243.

    External Resources

  43. Ferracci F, Moretto G, Gentile M, Kuo P, Carnevale A: Can seizures be the only manifestation of transient ischemic attacks? A report of four cases. Neurol Sci 2000;21:303–306.
  44. Cocito L, Loeb C: Focal epilepsy as a possible sign of transient subclinical ischemia. Eur Neurol 1989;29:339–344.
  45. Primavera A, Giberti L, Cocito L: Focal inhibitory seizures as the presenting sign of ischemic cerebrovascular disease. Ital J Neurol Sci 1993;14:381–384.
  46. Fisher CM: Transient paralytic attacks of obscure nature: the question of non-convulsive seizure paralysis. Can J Neurol Sci 1978:5:267–273.
  47. Schulz UGR, Rothwell PM: Transient ischemic attacks mimicking focal motor seizures. Postgrad Med J 2002;78:246–247.
  48. Cohen SN, Muthukumaran A, Gasser H, El-Saden S: Symptom spread to contiguous body parts as a presentation of cerebral ischemia. Cerebrovasc Dis 2002;14:84–89.
  49. Pohlmann-Eden B, Hoch DB, Cochius JI, Chiappa KH: Periodic lateralized epileptiform discharges – a critical review. J Clin Neurophysiol 1996;13:519–530.
  50. Hartings JA, Williams AJ, Tortella FC: Occurrence of nonconvulsive seizures, periodic epileptiform discharges, and intermittent rhythmic delta activity in rat focal ischemia. Exp Neurol 2003;179:139–149.
  51. De Reuck J, Goethals M, Vonck K, Van Maele G: Clinical predictors of late-onset seizures and epilepsy in patients with cerebrovascular disease. Eur Neurol 2005;54:68–72.
  52. De Reuck J, Claeys I, Martens S, Vanwalleghem Ph, Van Maele G, Phlypo R, Hallez H: Computed tomographic changes of the brain and clinical outcome of patients with seizures and epilepsy after an ischaemic hemispheric stroke. Eur J Neurol (in press).
  53. Luders HO, Dinner DS, Morris HH, Wyllie E, Comair YG: Cortical electrical stimulation in humans. The negative motor areas. Adv Neurol 1995;67:115–129.
  54. Cincotta M, Borgheresi A, Lori S, Fabbri M, Zaccara G: Interictal inhibitory mechanisms in patients with cryptogenic motor cortex epilepsy: a study of the silent period following transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 1998;107:1–7.
  55. Kessler KR, Schnitzler A, Classen J, Benecke R: Reduced inhibition with primary motor cortex in patients with poststroke focal motor seizures. Neurology 2002;59:1028–1033.
  56. Matsuoka H, Nakamura M, Ohno T, Shimabukuro J, Suzuki T, Numachi Y, Awata S: The role of cognitive-motor function in precipitation and inhibition of epileptic seizures. Epilepsia 2005;46(suppl 1):17–20.

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