Transient ischemic attacks and normal cerebral angiograms: a follow-up study.

To determine the outcome of patients with carotid transient ischemic attacks (TIAs) and normal cerebral angiograms, we assessed 68 patients (40 men, 28 women) aged 24-72 (mean 53.5) years for recurrent TIAs and strokes and for the development of cardiac disease over 2-6 (mean 4.4) years. All but one patient had a follow-up interview in early 1987; that patient had died of an unrelated cause (lung cancer) 18 months after the presenting TIA. The diagnosis was changed at the follow-up interview in three patients (multiple sclerosis, meningioma, migraine). Among the 64 remaining patients, at admission cranial computed tomography had shown cerebral infarction in 11 of 64, two-dimensional echocardiography had been abnormal in nine of 61, Holter monitoring had been abnormal in eight of 45, and twelve-lead electrocardiography had been abnormal in three of 64. Two patients had abnormalities on both echocardiography and Holter monitoring. At the follow-up interview of the 64 remaining patients, TIAs had recurred in nine and three had developed a completed stroke; cardiac disease (angina in seven, myocardial infarction in four) was noted in 11 patients. Findings from cardiac investigations on admission in the nine patients with recurrent TIAs had been abnormal in six and normal in three; all three patients who developed a stroke had had abnormal cardiac findings. Overall, further neurologic or cardiac events occurred in 12 of 46 patients (26%) with normal and in 10 of 18 patients (55.5%) with abnormal findings on admission (p less than 0.01). In the presence of normal angiograms, extensive cardiac investigations may help predict the outcome of patients with TIAs.