the diagnosis of transient ischemic attacks

140 Pages·2014·3.83 MB·English

THE DIAGNOSIS OF
TRANSIENT ISCHEMIC ATTACKS

THE DIAGNOSIS OF
TRANSIENT ISCHEMIC ATTACKS
De diagnose transient ischemic attack (TIA)
PROEFSCHRIFT
Ter verkrijging van de graad van doctor
aan de Erasmus Universiteit Rotterdam
op gezag van de Rector Magnificus
Prof. Dr. C.J. Rijnvos
en · volgens besluit van het college van Dekanen.
De openbare verdediging zal plaatsvinden op
woensdag 29 november 1989 om 13.45 uur
door
PIETER JAN KOUDSTAAL
Geboren te Rotterdam
Promotor: Prof. Dr. J. van Gijn
Promotor: Prof. Dr. A. Staal
Overige leden: Prof. Dr. H.F.M. Busch
Prof. Dr. J.R.T.C. Roelandt
From the Department of Neurology
University Hospital Dijkzigt Rotterdam
This study was supported by:
- Stichting Universiteitsfonds Rotterdam
The Dutch TIA trial is supported by:
- Dutch Heart Foundation
- ICI-Farma Rotterdam and ICI Pharmaceuticals, Great Britain
- ACF- Chemiefarma Maarssen
- Brocacef Maarssen
- University Hospital Utrecht
''Please listen to the patient,
he's trying to tell you what disease he has"
Michael H. Brooke [18]

CONTENTS
List of abbreviations
General introduction 1
Chapter I
Introduction 3
The development of the recognition of transient
ischemic attacks 3
The pathogenesis of transient ischemic attacks 5
The diagnosis of transient ischemic attacks 7
Main questions addressed in this thesis 11
Chapter II
Diagnosis of transient ischemic attacks: Improvement of
interobserver agreement by a check-list in ordinary language
(Stroke 1986; 17:723-728) 13
Chapter III
Clinical disagreement on the diagnosis of TIA: Is the patient
or the doctor to blame?
(Stroke 1989; 20:300-301) 24
Chapter IV
The Dutch TIA trial: Background and design
(Stroke 1988; 19:512-517) 26
Chapter V
Cerebral infarction on CT in patients with a TIA, RIND, or
partial stroke
(To be submitted for publication) 32
Chapter VI
Transient ischemic attacks with and without a relevant cerebral
infarct on CT cannot be clinically distinguished
(To be submitted for publication) 40
Chapter VII
Headache in acute cerebral ischemia
(To be submitted for publication) 49
Chapter VIII
"Atypical TIAs" may herald cardiac rather than cerebral events
(Submitted for publication) 59
General discussion 69
General summary 72
Samenvatting 77
References 82
Acknowledgements 94
Curriculum vitae 95
List of publications 96
Appendices
1. TIA Anamnese Scoringslijst (TAS) 99
2. TIA checklist 111
3. Dutch TIA trial: notification form, committees,
participants 117
LIST OF ABBREVIATIONS.
ASA Acetylsalicylic acid
CI Confidence Interval
CITS Cerebral Infarction with Transient Signs
CT(-scan) Computed Tomography (-scan)
DF Degrees of Freedom
ECG Electrocardiogram
EEG Electroencephalogram
GP General Practitioner
Hb Haemoglobulin
Ht Haematocrit
MI Myocardial Infarction
MRI Magnetic Resonance Imaging
PET Positron Emission Tomography
RIND Reversible Ischemic Neurological Deficit
SD Standard Deviation
TAS TIA- anamnese-scoringslijst
TIA Transient Ischemic Attack