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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

A Journal on Internal Medicine and Pharmacology


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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2002 February;161(1):1-5

language: English

Etiologic evaluation and diagnosis of cerebrovascular disease in the elderly

Bilora F. 1, Boccioletti V. 1, Pomerri F. 2, Pagiaro E. 2, Petrobelli F. 1, Girolami A. 1

1 Medical School, Department of Medical and Surgery Sciences, Second Chair of Medicine, University of the Study, Padua;
2 Radiology Institute, University of the Study, Padua


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Back­ground. The eti­ology in 40% of TIA (tran­sient ­ischemic ­attack)/­Stroke is dif­fi­cult to iden­tify. We ­tried to do ­this ­with non inva­sive diag­nostic meth­o­dology and ­with the ­help of ­three ­expert doc­tors (ED): a neu­rol­o­gist, a car­di­ol­o­gist and a neu­ro­ra­diol­o­gist. We ­then com­pared the diag­nosis of the phy­si­cian who ­took ­care of the ­patients (D) ­with ­that of the ­experts.
­Methods. We ­studied 149 ­patients ­with cereb­ro­vas­cular dis­eases but we ­excluded hemor­rhagic ­stroke. ­Male ­patients ­with TIA pre­sented the ­common ­risk fac­tors of ath­ero­scler­osis: dia­betes, ­smoking hab­itus and a ten­dency to hyper­ten­sion but no cor­re­la­tion ­with ­light or mod­erate ­grade of ­carotid sten­osis. ­Females had a ­strong prev­a­lence of ­atrial fib­ril­la­tion ­linked ­with TIA; the ­males ­mitral insuf­fi­ciency and ­anular ­aortic cal­cifi­ca­tion cor­re­lated ­with ­embolic TIA.
­Results. CT ­scan evi­denced ­focal ­lesions for ­women’s TIA and mul­ti­focal ­lesions for ­men’s TIA. ­There was diag­nostic con­cor­dance for TIA eval­u­ated by two med­ical ­equipes, but not for ­women’s ­stroke. The ED ­were ­more ­capable in deter­mining the ­etio-pathog­e­netic diag­nosis of cereb­ro­vas­cular dis­ease.
Con­clu­sions. A ­good eval­u­a­tion of clin­ical his­tory and non inva­sive diag­nostic meth­o­dology can ­reduce the unde­ter­mi­nated ­causes of cereb­ro­vas­cular dis­ease par­tic­u­larly in the eld­erly.

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