Background: We hypothesized that previous transient ischemic attack (TIA) had a favorable effect on early outcome after acute nonlacunar ischemic stroke. Methods: Data of 1,753 consecutive patients with ischemic stroke collected from a prospective hospital-based stroke registry were studied. A comparison was made of the groups with and without previous TIA. Favorable outcome included spontaneous neurological recovery or grades 0–2 of the modified Rankin scale at hospital discharge. Results: Previous TIA occurred in 55 (11.5%) of 484 patients with lacunar stroke and in 166 (13.1%) of 1,269 patients with nonlacunar stroke. The percentage of nonlacunar ischemic stroke patients with favorable outcome was 21.7% in those with a history of TIA compared to 15% without TIA (p < 0.03). In the lacunar stroke group, differences were not significant. In the multivariate analysis, TIA was an independent predictor of spontaneous in-hospital recovery. Conclusions: Prior TIA was associated with a favorable outcome in nonlacunar ischemic stroke, suggesting a neuroprotective effect of TIA possibly by inducing a phenomenon of ischemic tolerance allowing better recovery from a subsequent ischemic stroke.

Keywords:
Transient ischemia attack, Nonlacunar ischemic stroke, Outcome, Neurological recovery, Ischemic preconditioning
1.
Johnston SC: Transient ischemic attack. N Engl J Med 2002;347:1687–1692.
2.
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, Sherman DG, for the TIA Working Group: Transient ischemic attack – Proposal for a new definition. N Engl J Med 2002;347:1713–1716.
3.
Hakim AM: Could transient ischemic attacks have a cerebroprotective role? Stroke 1994;25:715–717.
4.
Moncayo J, de Freitas GR, Bogousslavsky J, Altieri M, van Melle G: Do transient ischemic attacks have a neuroprotective effect? Neurology 2000;54:2089–2094.
5.
Kirino T: Ischemic tolerance. J Cereb Blood Flow Metab 2002;22:1283–1296.
6.
Rothrock JF, Clark WM, Lyden PD: Spontaneous early improvement following ischemic stroke. Stroke 1995;26:1358–13560.
7.
Libman RB, Sacco RL, Shi T, Tatemichi TK, Mohr JP: Neurologic improvement in pure motor hemiparesis: Implications for clinical trials. Neurology 1992;41:1713–1716.
8.
Arboix A, Vericat MC, Pujades R, Massons J, Garcia-Eroles L, Oliveres M: Cardioembolic infarction in the Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry. Acta Neurol Scand 1997;96:407–412.
9.
Arboix A, Bechich S, Oliveres M, Garcia-Eroles L, Massons J, Targa C: Ischemic stroke of unusual cause: Clinical features, etiology and outcome. Eur J Neurol 2001;8:133–139.
10.
Grupo de Estudio de las Enfermedades Cerebrovasculares de la Sociedad Española de Neurología: Manejo del paciente con enfermedad vascular cerebral aguda. Recomendaciones 1992. Barcelona, Edos Ediciones, 1992.
11.
Arboix A, Alvarez-Sabín J, Soler L, for the Cerebrovascular Study Group of the Spanish Society of Neurology: Nomenclatura de las enfermedades vasculares cerebrales. Neurologia 1998;(suppl 1):1–10.
12.
Special Report from the National Institute of Neurological Disorders and Stroke: Classification of cerebrovascular diseases. Part 3. Stroke 1990;21:637–676.
13.
Arboix A, Massons J, García-Eroles L, Oliveres M, Balcells M, Targa C: Migrainous cerebral infarction in the Sagrat-Cor Hospital of Barcelona stroke registry. Cephalalgia 2003;23:389–394.
14.
Arboix A, Morcillo C, García-Eroles L, Massons J, Oliveres M, Targa C: Different vascular risk factor profiles in ischemic stroke subtypes. The Sagrat Cor Hospital of Barcelona Stroke Registry. Acta Neurol Scand 2000;102:264–270.
15.
Arboix A, Martí-Vilalta JL: Transient ischemic attacks in lacunar infarcts. Cerebrovasc Dis 1991;1:20–24.
16.
Arboix A, García-Eroles L, Massons J, Oliveres M, Targa C: Hemorrhagic lacunar stroke. Cerebrovasc Dis 2000;10:229–234.
17.
Arboix A, Padilla I, García-Eroles L, Massons J, Comes E, Targa C: Pure motor hemiparesis: A clinical study of 222 patients. J Neurol Neurosurg Psychiatry 2001;71:239–242.
18.
Bamford JM, Sandercock PAG, Warlow CO, Slattery J: Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989;20:828.
19.
Silver FL, Norris JW, Lewis AJ, Hachinski VC: Early mortality following stroke: A prospective review. Stroke 1984;15:492–496.
20.
Hosmer DW, Lemershow S: Applied Logistic Regression. New York, Wiley, 1989, pp 25–37.
21.
Hosmer DW, Lemershow S: Goodness of fit tests for the multiple logistic regression model. Commun Stat 1980;A9:1043–1069.
22.
Burgueño MJ, García-Bastos JL, González-Buitrago JM: Las curvas ROC en la evaluación de las pruebas diagnósticas. Med Clin (Barc) 1995;104:661–670.
23.
Norusis MJ: SPSS Advanced Statistical Student Guide. Chicago, SPSS, Inc, 1990.
24.
Dixon WJ: BMDP Statistical Software Manual. Berkeley, University of California Press, 1990, pp 330–334.
25.
Humphrey P: Stroke and transient ischaemic attacks. J Neurol Neurosurg Psychiatry 1994;57:534–543.
26.
Weih M, Kallenberg K, Bergk A, Dirnagl U, Harms L, Wernecke KD, Einhaupl KM: Attenuated stroke severity after prodromal TIA: A role for ischemic tolerance in the brain. Stroke 1999;30:1851–1854.
27.
Kitagawa K, Matsumoto M, Tagaya M, Hata R, Ueda H, Niinobe M, et al: ‘Ischemic tolerance’ phenomenon found in the brain. Brain Res 1990;528:21–24.
28.
Tomai F, Crea F, Chiariello L, Gioffre PA: Ischemic preconditioning in humans: Models, mediators, and clinical relevance. Circulation 1999;100:559–563.
29.
Blanco M, Leira R, Lizasoain I, Moro MA, Davalos A, Castillo J: Ischemic tolerance biochemical factor in transitory ischemic attack patients (abstract). Cerebrovasc Dis 2003;16(suppl 4):6.
30.
Lizasoain I, Pradillo JM, Pereira MP, Cardenas A, Leza JC, Moro MA, Lorenzo P, Davalos A, Castillo J: In vivo ischemic preconditioning involves up-regulation of TNF receptor I (abstract). Cerebrovasc Dis 2003;16(suppl 4):103.
31.
Fisher CM: Lacunar infarcts. Cerebrovasc Dis 1991;1:311–320.
32.
Mohr JP, Martí-Vilalta JL: Lacunes; in Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds): Stroke. Pathophysiology, Diagnosis, and Management. Philadelphia, Churchill Livingstone, 1998, pp 599–622.
33.
Tsiskaridze A, de Freitas GR, Bogousslavsky J: Stroke patterns with transient ischemic attacks (abstract). Cerebrovasc Dis 2000;10(suppl 2):104.
34.
Glazier SS, O’Rourke DM, Graham DI, Welsh FA: Induction of ischemic tolerance following brief focal ischemia in rat brain. J Cereb Blood Flow Metab 1994;14:545–553.
35.
Castillo J, Moro MA, Blanco M, Leira R, Serena J, Lizasoain I, Davalos A: The release of tumor necrosis factor-α is associated with ischemic tolerance in human stroke. Ann Neurol 2003;54:811–819.
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2004
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