an Arnold - Chiari

Abstract

A recent report from the UK-TIA Study Group2 presented 11 cases of intracranial tumours among 2449 patients with transient ischaemic attacks or minor strokes. Occasional cases of small cerebral haematomas have been found in patients with minor strokes,3 but only exceptionally in patients with transient ischaemic attacks.4 In a CT scan study of 284 cases with transient ischaemic attacks5 five patients had a mass lesion; none a brain haematoma. We present the results of a prospective CT scan study of 175 patients (63 with transient ischaemic attacks and 112 with minor deficits lasting longer than 24 hours) recruited in the emergency rooms of two general hospitals. In every case, the CT scan (CX Tomoscan, Philips) was performed within the first week of the clinical event (with a mean delay of 13 (SD 24) hours). The mean age of the patients was 68 (8-5) years; 132 events were located in the carotid artery territory, 38 in the vertebrobasilar territory and five were of uncertain location. The CT scan was normal in 114 patients. Low density areas compatible with infarction were present in 56. Nonischaemic causes of the presenting symptoms were found in three minor cases of stroke-namely; a brain tumour, compatible with an extensive hemispheric malignant glioma by MRI and biopsy features; a small occipital haematoma; and a medium sized basal ganglia haematoma (associated with an ipsilateral subdural haematoma). All three patients were over 60 and had at least one vascular risk factor. In one of the cases of transient ischaemic attack a mass located on the clivus (compatible by CT features with a meningioma) was considered to have caused cerebral symptoms through compression of the basilar artery. Also aetiologically related to the symptoms could have been a minor stroke case with a thrombosed middle cerebral artery bifurcation aneurysm, demonstrated by MRI angiography. The number of cases in our study is insufficient to support definite conclusions. The yield of CT scan for the detection of non-ischaemic causes (such as cerebral and subdural haematoma and brain tumour) in minor strokes (cases with symptoms lasting longer than 24 hours) was 2-7% (95% CI 0 to 5-7) and in transient ischaemic attacks the yield was 1-6% (95% CI 0 to 4 7). M GARCIA-ESCRIG A PEREZ-SEMPERE L CALANDRE F VIILLAVERDE M DE LA FUENTE E CLAVERIA Neurology and Neuroradiology Sections, 12 de Octubre Hospital, Madrid, and Neurology Section, Segovia General Hospital, Segovia, Spain

Cite this paper

@inproceedings{GarcaEscriganA, title={an Arnold - Chiari}, author={M Garc{\'i}a-Escrig and Angel P{\'e}rez-Sempere and Luis Calandre and F Viillaverde and M De and La Fuente and E Claveria} }