Transient ischemic attack reported with paroxetine use

OBJECTIVE: To report the occurrence of a transient ischemic attack (TIA) temporally related to the initiation of paroxetine. CASE SUMMARY: A 57-year-old white man with a history of intermittent atrial fibrillation and hypercholesterolemia developed slurred speech and a facial droop 3 days after starting paroxetine. He was diagnosed with a TIA, hospitalized, and given anticoagulation treatment. The presenting symptoms resolved, but recurred when paroxetine was restarted 2 days later. DISCUSSION: Platelets secrete serotonin, which mediates vasoconstriction through stimulation of 5-HT2a receptors. This is counterbalanced by the release of the vasodilator nitric oxide upon serotonin stimulation of endothelial 5-HT1 receptors. In conditions such as atherosclerosis, the damage to the endothelium leads to a greater vasoconstrictive response. Paroxetine has been reported to weakly inhibit norepinephrine reuptake and nitric oxide production in addition to increasing serotonergic activity, potentially compounding the vasoconstrictive response. An objective causality assessment revealed that the TIA was probably an adverse event resulting from use of paroxetine. CONCLUSIONS: Use of paroxetine and other selective serotonin-reuptake inhibitors may result in changes of the vasculature and subsequent ischemic events in predisposed patients.     

短暂性脑缺血发作与血小板颗粒膜蛋白140的关系

目的:探讨血小板颗粒膜蛋白140水平的测定,对提示短暂脑缺血发作的意义。方法:选取2003-01/06大连医科大学第二临床学院神经内科住院确诊为短暂性脑缺血发作的患者80例,测定血浆血小板颗粒膜蛋白140及血浆血栓烷B2水平,并将他们分为无梗死组及有梗死组,同时与健康人30例进行对照。结果:有梗死组、无梗死组和健康对照组血浆血小板颗粒膜蛋白140水平分别为:(27.72±5.98),(24.55±5.29),(15.42±5.07)ng/L,血浆血栓烷B2的水平分别为:(148.36±38.28),(133.81±38.16),(124.48±30.16)ng/L,有梗死组两因子的水平均明显高于对照组(P<0.01),无梗死组血浆血小板颗粒膜蛋白140明显高于对照组(P<0.01),而血浆血栓烷B2与健康对照组差异无显著性意义。有梗死组血浆血小板颗粒膜蛋白140水平高于无梗死组(P<0.05),而血浆血栓烷B2水平差异无显著性意义。结论:血小板颗粒膜蛋白140与短暂性脑缺血发作关系密切,血浆血小板颗粒膜蛋白140浓度测定能准确反映血小板活化的程度,它的测定为预测及对短暂性脑缺血发作进行干预提供了新方法。     

Delayed ischemic stroke associated with methamphetamine use

A 19-year-old woman had right occipital infarction 3 months after she had injected methamphetamine. No other possible causes of stroke could be found in this case. Magnetic resonance angiography revealed beading of the right posterior cerebral artery, which suggested vasculitis. Her symptoms were right-sided headache, left superior quadrant hemianopia, and left hypesthesia, which gradually improved without any treatment. Methamphetamine has been known to cause hemorrhagic and ischemic stroke relatively soon after administration. We report here that methamphetamine may also cause chronic cerebral vasculitis and delayed ischemic stroke.     

椎基底动脉系统短暂性脑缺血发作与患者的记忆功能

目的:探讨椎基底动脉系统短暂性脑缺血发作(transientischemicattack,TIA)与记忆障碍的关系。方法:采用《临床记忆量表》甲式对30例椎基底动脉系统TIA患者和30例正常对照者进行记忆检查和评定,两组资料在性别、年龄、文化程度和利手间差异无显著性意义。结果:椎基底动脉系统TIA患者的总分与基础分值的百分比(71.0±19.0)%、记忆商数(84.0±17.0)%、指向记忆(14.1±5.2)%、联想学习(13.0±5.1)%和图像自由回忆成绩(13.0±5.0)%与正常对照组(81.0±17.0)%,(92.0±14.0)%,(16.5±5.6)%,(15.2±4.2)%,(16.0±5.2)%比较差异有显著性意义(t=1.720～2.418,P<0.05),无意义图形再认和人像特点联系回忆成绩间差异无显著性意义(P>0.05)。结论:椎基底动脉系统TIA患者存在记忆障碍,与脑循环障碍和脑代谢障碍致脑功能降低有关。     

Transient ischemic attack (TIA): the initial diagnostic and therapeutic dilemma

Many patients with transient ischemic attacks (TIA) are at high risk of stroke within the first few days of onset of symptoms. Emergency physicians and primary care physicians need to assess these patients quickly and initiate appropriate secondary stroke prevention strategies. Recent refinements in diagnostic imaging have produced valuable insight into risk stratification of patients with TIA. Clinical data regarding urgent initiation of antiplatelet therapy specifically in this patient population with non-cardioembolic TIA are limited but promising. This review outlines the diagnostic tools available for rapid assessment of patients presenting with symptoms of TIA and discusses clinical trials that apply to these vulnerable patients.     

Transient ischemic attack after mRNA-based COVID-19 vaccination during pregnancy: A case report

BACKGROUNDThrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines. The syndrome is characterized by thrombosis, especially cerebral venous sinus thrombosis, and may lead to stroke. Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications. We present the case of a 24-year-old pregnant woman with a transient ischemic attack (TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine (at 37 2/7 wk).CASE SUMMARYTIA occurred 13 d following the coronavirus disease vaccination. At 39 1/7 wk of pregnancy, the patient presented with sudden onset of right eye blurred vision with headache, dizziness with nausea, right-hand weakness, anomia, and alexia. The symptoms lasted 3 h; TIA was diagnosed. Blood test results revealed elevated D-dimer, cholesterol, and triglyceride levels. Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke. At pregnancy 37 6/7 wk, she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor. Body mass index on admission was 19.8 kg/m². Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities. The next day, a mature female baby weighing 2895 g and measuring 50 cm was delivered. Apgar scores were 8 and 9 in the first and fifth minutes. D-dimer levels decreased on postoperative day 4. After discharge, the autoimmune panel was within normal limits, including antinuclear and antiphospholipid antibodies. CONCLUSIONTIA might be developed after the mRNA vaccines in pregnant women.     

Transient ischemic attacks.

The treatment of TIA must be individualized. TIA is one of several manifestations of generalized atherosclerosis. While one-third of patients with TIA will suffer a stroke in five years, one-half of the same group will die of myocardial infarction. The risk of stroke is greater in carotid rather than vertebral-basilar TIA, in older patients, and in those with a cluster of TIAS, an is highest in the first month after the TIA. Treatment should reflect this knowledge.     

磁共振扩散加权成像对短暂性脑缺血发作的诊断价值

目的评价短暂性脑缺血发作（TIA）患者磁共振扩散加权成像（DWI）急性缺血病灶发生率,DWI急性缺血病灶和临床特征的关系。方法分析2006年3-10月间在发病后7天内进行常规MRI和DWI检查的126例TIA患者的资料。比较TIA患者DWI表现和临床特征的关系。结果52例TIA患者有DWI急性缺血病灶（52/126,41%）。病灶体积较小（平均体积：1.6cm^3）,ADC值中度下降（平均ADC比率：76%）。Logistic回归分析显示TIA持续时间大于或等于30min（OR,6.9;95%CI,3.2～23.4）,运动障碍（OR,4.8;95%CI,1.9～19.2）和失语（OR,7.8;95%CI,1.9～27.9）是DWI异常的预示因素。52例有DWI异常者中19例在常规MRI上未显示病灶。结论在临床诊断的TIA患者中,近一半有DWI异常,DWI异常与症状持续时间,运动障碍和失语相关。