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1. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005 , , ,

Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
Markus H, Culliane M. Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
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2. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 1, 2005, No. 2 , , ,

An important cause of transient ischemic attack (TIA) and stroke is atherosclerotic carotid artery stenosis.
An important cause of transient ischemic attack (TIA) and stroke is atherosclerotic carotid artery stenosis. It accounts for about 20% of cases of brain infarction and has the highest recurrent stoke risk compared to all other subtypes of stroke [2, 3]. Therefore, rapid intervention in this patient group is needed and they should be managed efficiently to minimize the incidence of stroke.
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Unfortunately, only 15% of stroke patients first present with classic TIA symptoms – slurred speech (dysarthia), limb weakness or numbness, transient monocular blindness (amaurosis fugax), unsteadiness (ataxia) or difficulty speaking (dysphasia) [4].
Unfortunately, only 15% of stroke patients first present with classic TIA symptoms – slurred speech (dysarthia), limb weakness or numbness, transient monocular blindness (amaurosis fugax), unsteadiness (ataxia) or difficulty speaking (dysphasia) [4]. Patients presenting with these symptoms should be examined and screened for carotid stenosis, within 24–48 hours after onset of symptoms.
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Also, the patients who have had stroke three months prior to procedure will benefit more from surgery then those with TIA.
Both studies showed that the benefit of endarterectomy is greater for men then for women, for patients aged 75 and older and for patients with hemispheric symptoms. Also, the patients who have had stroke three months prior to procedure will benefit more from surgery then those with TIA. Studies suggested that a higher risk of preoperative ischemic event or death exists in patients with diabetes, elevated blood pressure, contralateral carotid occlusion and left-sided disease. Also, patients randomized for surgical treatment within 2 weeks after their last ischemic event, benefit more from surgery [9].
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The hemorheological investigation showed increase of Hct, Fib, WBV and PV in the patients with TIA and UCI; it was more pronounced in the UCI patients.
The hemorheological investigation showed increase of Hct, Fib, WBV and PV in the patients with TIA and UCI; it was more pronounced in the UCI patients. Significant increase of Hct and WBV in the stroke risk group was also found. The elevation of Chol and Tg predominated in the patients with UCI and in the subjects with risk factors for stroke. These lipid variables correlated significantly with PV in the TIAs` and stroke risk groups.
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3. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 2 , , ,

Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
Markus H, Cullinane M. Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
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4. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 1 , , ,

Recent studies of diffussion-perfussion weighted imaging in patients with stroke and TIA provide a new insighit into the pathophysiology of the focal cerebral ischemia.
Recent studies of diffussion-perfussion weighted imaging in patients with stroke and TIA provide a new insighit into the pathophysiology of the focal cerebral ischemia. The infarct core, the ischemic penumbra and regions of oligemia have been visualized. The ischemic penumbra has been defined as an ischemic zone with reduced blood flow and absent bioelectrical activity, in which the ion homeostasis is not irreversibly disturbed. Initially, the ischemic penumbra in stroke patients has been demonstrated
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Recently, it has been pointed out that from pathophysiological viewpoint TIA could be defined as an ischemic penumbra of varied duration, which may proceed to cerebral infarction or reduce to oligemia.
by positron emission tomography and it has been shown that the penumbra could last several hours after a symptom onset. Now the diffussion-perfussion MRI is widely used to demonstrate the ischemic penumbra and to follow when it proceed to cerebral infarction. It has been also shown that the penumbra in stroke patients can be a long-lasting perfussion abnormality. Thus, the visualization of the penumbra allows the treatment decision to be made on the base of the cerebral ischemia pathophysiology, but not on the duration of the neurological deficit. Recently, it has been pointed out that from pathophysiological viewpoint TIA could be defined as an ischemic penumbra of varied duration, which may proceed to cerebral infarction or reduce to oligemia. The neuroprotection in cerebral ischemia is designed to block different stages of the ischemic cascade and to attenuate the pathological apoptosis. The neuroprotective drugs belong to different pharmacological groups and possess various modes of action. They include inhibitors of glutamate release, antagonists of NMDA receptor, GABAA agonists, Ca
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However the cases of asymptomatic stenosis and even obstruction of carotid arteries proves the effectiveness of aforementioned mechanisms to maintain the flow and 0-point in changed (in relatively wide diapason) conditions, or to restore the balance in a short time, as in TIA.
, because of diminished quantity of blood. However the cases of asymptomatic stenosis and even obstruction of carotid arteries proves the effectiveness of aforementioned mechanisms to maintain the flow and 0-point in changed (in relatively wide diapason) conditions, or to restore the balance in a short time, as in TIA.
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The asymptomatic findings are example of this, the reversible symptomatic in TIA.
In pathology, the deviations may be compensated to some extent. The asymptomatic findings are example of this, the reversible symptomatic in TIA. Sometimes the compensatory influences of the whole system are not enough to correct the impaired autoregulation in the subsystem. It is found that in the affected hemisphere MCA, increased blood pressure and cardiac output caused a blood flow velocity, which is one forth lower, than those in the unaffected side (Tribe J et al, 1996).
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The genesis of the hyperperfusion syndrome is better understood in the light of this presentation, as well as are TIA.
syndrome”. It may be also the capillary 0-point displacement and increased ischemia of the brain tissue. The genesis of the hyperperfusion syndrome is better understood in the light of this presentation, as well as are TIA.
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The hemorheological investigation reveals significant increase of fibrinogen and plasma viscosity in the patients with TIA and of whole blood viscosity at different shear rates in all patients` groups.
lesterol and triglycerides predominates in the patients with RF for CVD and CCI. The hemorheological investigation reveals significant increase of fibrinogen and plasma viscosity in the patients with TIA and of whole blood viscosity at different shear rates in all patients` groups. The increase of IEA is significant only in the patients with CCI and the decrease of TO
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From pathophysiological viewpoint he defines the TIA as a ischemic penumbra with different duration, which could proceed to cerebral infarct or reduce to benign oligemia and pointed out that TIA is an ideal target for rapid reperfusion and neuroprotection.
67 of which are printed in international journals or books and are widely cited, more than 800 citations. His method for quantitative evaluation of cerebral blood flow by impedance technique, known as “method of Hadjiev” in the international literature, has been published in “Progress in Brain Research” He introduces the concept of asymptomatic ischemic cerebrovacular disorders, published in books and papers, including in foreign journals. From pathophysiological viewpoint he defines the TIA as a ischemic penumbra with different duration, which could proceed to cerebral infarct or reduce to benign oligemia and pointed out that TIA is an ideal target for rapid reperfusion and neuroprotection. Author of guidelines for primary and secondary prevention of ischemic stroke. He is an Editor of textbooks and manuals of Neurology. Prof. D. Hadjiev has delivered lectures on cerebrovascular diseases and headache in Austria, Croatia and Turkey. He has conducted and supervised 10 dissertations and 9 of his post-graduate students are habilitated.
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5. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 2 , , ,

Therefore, the best possible antithrombotictherapyforsecondaryprevention should be selected according to the individual needs,especiallytolerabilityinsymptomatic patients with carotid artery stenosis, antithrombotic therapy should be initiated as soon as the diagnosis of a TIA or cerebral infarction has been made [5].
Patients with stroke are prone to a recurrent stroke [4]. Therefore, the best possible antithrombotictherapyforsecondaryprevention should be selected according to the individual needs,especiallytolerabilityinsymptomatic patients with carotid artery stenosis, antithrombotic therapy should be initiated as soon as the diagnosis of a TIA or cerebral infarction has been made [5]. Alternative choices are acetylsalicylic acid (ASA) [6], a combination of ASA and extended release dipyridamole (DP) [7, 8], or clopidogrel [9]. At present, the first choice is the combination of ASA + extended release DP. The regimen used in ESPS2 trial [7] (ASA 25 mg x 2/d + DP 200 mg x 2/d) diminished the risk of brain infarct 21.3% when compared with treatment with ASA alone without increasing the risk of bleeding (absolute risk reduction 3.0% dur-
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f the reason for TIA or brain infarction is atherosclerosis, antiplatelet therapy should be continued permanently, if there are no contraindications (e.g.
f the reason for TIA or brain infarction is atherosclerosis, antiplatelet therapy should be continued permanently, if there are no contraindications (e.g. ulcer, thrombocytopenia, therapy resistant elevated BP). Otherwise, therapy continues until the risk factor inducing symptoms disappeares.
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6. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 1 , , ,

Crescendo TIA’s needs a faster and more definite assessment than a doubtful symptom a month ago.
be sufficient to differentiate between clearly normal and pathologic results and to add other diagnostic modalities in case of any suspected pathology. This has to be seen not only on a technical background but also on a clinical one. Crescendo TIA’s needs a faster and more definite assessment than a doubtful symptom a month ago. Any discussion about clinical decision making should be addressed in the frame of the 3 levels of training and competence as defined by the EFSUMB or a correspondent national definition.
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(39.3%) са имали ипсилатерална TIA и 14 (28%) са имали контралатерална каротидна стеноза над 50%.
(39.3%) са имали ипсилатерална TIA и 14 (28%) са имали контралатерална каротидна стеноза над 50%. Много важен е фактът, че при всички 51 болни е имало прогресия на неврологичния дефицит след първия мозъчносъдов инцидент. С КТ и ЯМР са установени нови, клинично неизявени инсулти, което е било индикация за извършване на процедурата.
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TIA
TIA
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“TIA Clinic”.
Транзиторната исхемична атака (ТИА) е критично състояние, което трябва да се третира като „остър мозъчносъдов инцидент”. Рискът от развитие на мозъчен инфаркт в краткосрочен и дългосрочен план е значимо по-висок в сравнение с останалата популация. Създадените клинични скали като Калифорния-скала, ABCD и обединената ABCD(2) са лесно достъпни за установяване на практическия риск и позволяват спешно селектиране на рисковите пациенти с ТИА. Интерпретацията на съпътстващите независими рискови фактори и включването на резултати от специализирани биохимични изследвания, ултразвукова диагностика и невроизобразяващи методи, дава значително по-детайлна представа за прогноза и вероятност. Съвременната концепция за ТИА като състояние, изискващо спешност, е намерила практическа реализация в създаването на т. нар. “TIA Clinic”.
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Transient ischemic attack (TIA) is a medical emergency and must be treated as an „acute cerebrovascular accident”.
Transient ischemic attack (TIA) is a medical emergency and must be treated as an „acute cerebrovascular accident”. The risk of subsequent stroke both soon and long after TIA is significantly higher compared with other the population group. Existing clinical scales, as California score, ABCD score and unified ABCD(2) score are easy of access markedly available to identify practical risk management and allow selection of emergency patients with TIA. Independent interpretation of accompanying risk factors and integrated data as a result of specialized biochemical tests, ultrasound diagnostics and neuroimaging methods provide more detailed picture of the prognosis and probability. The modern concept of TIA as a condition requiring emergency has found practical realization in the creation of so-called “TIA Clinic”.
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The risk of subsequent stroke both soon and long after TIA is significantly higher compared with other the population group.
Transient ischemic attack (TIA) is a medical emergency and must be treated as an „acute cerebrovascular accident”. The risk of subsequent stroke both soon and long after TIA is significantly higher compared with other the population group. Existing clinical scales, as California score, ABCD score and unified ABCD(2) score are easy of access markedly available to identify practical risk management and allow selection of emergency patients with TIA. Independent interpretation of accompanying risk factors and integrated data as a result of specialized biochemical tests, ultrasound diagnostics and neuroimaging methods provide more detailed picture of the prognosis and probability. The modern concept of TIA as a condition requiring emergency has found practical realization in the creation of so-called “TIA Clinic”.
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Existing clinical scales, as California score, ABCD score and unified ABCD(2) score are easy of access markedly available to identify practical risk management and allow selection of emergency patients with TIA.
Transient ischemic attack (TIA) is a medical emergency and must be treated as an „acute cerebrovascular accident”. The risk of subsequent stroke both soon and long after TIA is significantly higher compared with other the population group. Existing clinical scales, as California score, ABCD score and unified ABCD(2) score are easy of access markedly available to identify practical risk management and allow selection of emergency patients with TIA. Independent interpretation of accompanying risk factors and integrated data as a result of specialized biochemical tests, ultrasound diagnostics and neuroimaging methods provide more detailed picture of the prognosis and probability. The modern concept of TIA as a condition requiring emergency has found practical realization in the creation of so-called “TIA Clinic”.
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The modern concept of TIA as a condition requiring emergency has found practical realization in the creation of so-called “TIA Clinic”.
Transient ischemic attack (TIA) is a medical emergency and must be treated as an „acute cerebrovascular accident”. The risk of subsequent stroke both soon and long after TIA is significantly higher compared with other the population group. Existing clinical scales, as California score, ABCD score and unified ABCD(2) score are easy of access markedly available to identify practical risk management and allow selection of emergency patients with TIA. Independent interpretation of accompanying risk factors and integrated data as a result of specialized biochemical tests, ultrasound diagnostics and neuroimaging methods provide more detailed picture of the prognosis and probability. The modern concept of TIA as a condition requiring emergency has found practical realization in the creation of so-called “TIA Clinic”.
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Prognostic scales for TIA
Prognostic scales for TIA
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Prognostic scales for TIA
Prognostic scales for TIA
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TIA Clinic.
Съвременната представа за ТИА като състояние, изискващо спешност, е намерила практическа реализация в създаването на т. нар. TIA Clinic. Специално внимание се обръ-
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Клиниките SOS-TIA се организират с цел бърз и леснодостъпен денонощен прием (24 часа/7 дни седмично) за всички пациенти с реални или суспектни преходни нарушения на мозъчното кръвообращение.
ща на високорисковия контингент с 6-7 точки по ABCD(2) при първоначалния преглед на пациенти, приемащи антикоагулантна терапия и при наличие на рецидивиращи ТИА, т. е. 2 или повече съдови инциденти седмично. През 2008 год. P. Amarenco и съавт. [4, 25] представят обединена концепция за специализирани заведения за болни с ТИА. Клиниките SOS-TIA се организират с цел бърз и леснодостъпен денонощен прием (24 часа/7 дни седмично) за всички пациенти с реални или суспектни преходни нарушения на мозъчното кръвообращение. Основните насоки са: диагностично и етиологично уточняване на пациенти с ТИА до 4 или по-малко часа от началото на възникване на клиничните симптоми и започване на ранна прицелна вторична профилактика. Първоначалното селектиране на пациенти се осъществява въз основа на клиничната
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Prognostic scales for TIA
Prognostic scales for TIA
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Should a specific TIA clinic be organised?
Kaste M, Korner J, Albers G, Alberts MJ. Should a specific TIA clinic be organised? 17th European Stroke Conference, France, 2008.
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Performance of the ABCD and ABCD2 scores in TIA patients with carotid stenosis and atrial fibrillation.
Koton S, Rothwell PM. Performance of the ABCD and ABCD2 scores in TIA patients with carotid stenosis and atrial fibrillation.
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The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients.
Purroy F, Begué R, Quílez A, Piñol-Ripoll G, Sanahuja J, Brieva L, Setó E, Gil MI. The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients.
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Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study.
Selvarajah JR, Smith CJ, Hulme S, Georgiou RF, Vail A, Tyrrell PJ, NORTHSTAR Collaborators. Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study.
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The North Dublin TIA Study.
Sheehan OC, Kyne L, Kelly LA, Hannon N, Marnane M, Merwick A, McCormack PM, Duggan J, Moore A, Moroney J, Daly L, Harris D, Horgan G, Williams EB, Kelly PJ. Population-Based Study of ABCD2 Score, Carotid Stenosis, and Atrial Fibrillation for Early Stroke Prediction After Transient Ischemic Attack. The North Dublin TIA Study.
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Who Should be Hospitalized Following a TIA?
Spittler LK. Who Should be Hospitalized Following a TIA?
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7. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2 , , ,

The Significance of Asymptomatic Carotid Stenosis and Dyslipidemia for TIA and Ischemic Strokes in Patients with Multiple Vascular Risk Factors – Population-Based Study.
The Significance of Asymptomatic Carotid Stenosis and Dyslipidemia for TIA and Ischemic Strokes in Patients with Multiple Vascular Risk Factors – Population-Based Study.
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THE SIGNIFICANCE OF ASYMPTOMATIC CAROTID STENOSIS AND DYSLIPIDEMIA FOR TIA AND ISCHEMIC STROKES IN PATIENTS WITH MULTIPLE VASCULAR RISK FACTORS – POPULATION-BASED STUDY
THE SIGNIFICANCE OF ASYMPTOMATIC CAROTID STENOSIS AND DYSLIPIDEMIA FOR TIA AND ISCHEMIC STROKES IN PATIENTS WITH MULTIPLE VASCULAR RISK FACTORS – POPULATION-BASED STUDY
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8. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 2 , , ,

This lead to the CHADS2 and later to the CHA2DS2VASc risk score, considering as risk factors congestive heart failure, hypertension, age (2 points if >75 years, 1 point if 65-74 years), diabetes, prior stroke/TIA (2 points), vascular disease and female gender [24].
Cardioembolic risk is not uniform in all patients with AF. The Stroke Risk in Atrial Fibrillation Working Group performed a systematic review of studies using multivariate regression techniques to identify independent risk factors for stroke in patients with AF, and reported absolute stroke rates in subgroups of patients with these risk factors collected [29]. This lead to the CHADS2 and later to the CHA2DS2VASc risk score, considering as risk factors congestive heart failure, hypertension, age (2 points if >75 years, 1 point if 65-74 years), diabetes, prior stroke/TIA (2 points), vascular disease and female gender [24]. For treatment purposes, anticoagulation is recommended with a score of at least 2 [6].
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Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
Markus H, Cullinane M. Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
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9. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 2 , , ,

Atrial septal defect and consequently the existence of right-to-left cardiac shunt (RLS) is a very common etiological factor in the onset of ischemic stroke and transient ischemic attack (TIA) in younger patients.
Atrial septal defect and consequently the existence of right-to-left cardiac shunt (RLS) is a very common etiological factor in the onset of ischemic stroke and transient ischemic attack (TIA) in younger patients. Since the contrast transesophageal echocardiography (c-TEE) is considered the “gold” standard for right-to-left cardiac shunt detection, we compared its sensitivity with the sensitivity of contrast-enhanced transcranial Doppler ultrasound (TCD). We also studied the influence of vascular risk factors on TCD parameters.
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Vascular risk factors are etiologically important in the formation of atherosclerotic plaques, which may be the cause of ischemic stroke and/ or TIA.
Vascular risk factors are etiologically important in the formation of atherosclerotic plaques, which may be the cause of ischemic stroke and/ or TIA. However, studies have shown that atherosclerosis as an etiological factor in the occurrence of ischemic stroke or TIA is more common in patients without PFO (R-L shunt) than in patients with PFO [8]. This can be explained by the fact that the reasons for cerebral ischemia in young people, in whom R-L shunt is mostly detected, are not primarily atherosclerotic processes, but other rarer non-atherosclerotic etiological factors, including interatrial septal abnormalities commonly associated with R-L shunt and probable paradoxical embolization.
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However, studies have shown that atherosclerosis as an etiological factor in the occurrence of ischemic stroke or TIA is more common in patients without PFO (R-L shunt) than in patients with PFO [8].
Vascular risk factors are etiologically important in the formation of atherosclerotic plaques, which may be the cause of ischemic stroke and/ or TIA. However, studies have shown that atherosclerosis as an etiological factor in the occurrence of ischemic stroke or TIA is more common in patients without PFO (R-L shunt) than in patients with PFO [8]. This can be explained by the fact that the reasons for cerebral ischemia in young people, in whom R-L shunt is mostly detected, are not primarily atherosclerotic processes, but other rarer non-atherosclerotic etiological factors, including interatrial septal abnormalities commonly associated with R-L shunt and probable paradoxical embolization.
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Our research has shown that there is no statistically significant correlation between vascular risk factors and “bubble test” results in patients with ischemic stroke/TIA.
Our research has shown that there is no statistically significant correlation between vascular risk factors and “bubble test” results in patients with ischemic stroke/TIA. This may be due to the mainly younger population (mean age of the tested group 36 years), and to the fact that atherosclerotic changes in them were not pronounced enough to have a significant,
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Moreover, a statistically significant correlation between c-TCD findings (presence of R-L shunt) and DVT, as possible source of thromboembolus and possible subsequent development of paradoxical embolism, suggests that it is necessary to insist on detection of interatrial septal abnormalities as potential sites of R-L shunt in patients with TIA and/or ischemic stroke.
Moreover, a statistically significant correlation between c-TCD findings (presence of R-L shunt) and DVT, as possible source of thromboembolus and possible subsequent development of paradoxical embolism, suggests that it is necessary to insist on detection of interatrial septal abnormalities as potential sites of R-L shunt in patients with TIA and/or ischemic stroke. The reason for the low incidence of DVT detected in our study could be interpreted by the fact that it was the aim of testing in all patients and in some patients it was detected only in the lower extremities where DVT is most commonly present. However, this does not exclude the possibility that in a certain number of patients a potential source of paradoxical embolism of second localization (e.g. Mesenteric vein) was not detected, or that the ultrasound examination was postponed after the organization or dissolution of DVT, which could have been previously a source of paradoxical embolism and cerebral ischemia.
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The study included 30 healthy subjects, 28 patients with transient ischemic attacks (TIA) and 30 patients with chronic unilateral cerebral infarctions (CUCI).
The study included 30 healthy subjects, 28 patients with transient ischemic attacks (TIA) and 30 patients with chronic unilateral cerebral infarctions (CUCI). In all of them the auditory system was stimulated with pure tone of 1000 Hz and intensity of 100 dB for 30 sec, while the vestibular system was stimulated calorically – irrigation of outer ear canal with cold water. The velocity parameters of the blood flow in the middle cerebral artery (MCA) were monitored by transcranial Doppler sonography before and after the stimulation.
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It is more expressed after vestibular stimulation and predominates in the patients with TIA, where significant increase of the DBF was observed.
auditory stimulus caused increase only of the SBF. The tendency for increase of the velocity parameters of the MCA is preserved in the patients with cerebrovascular diseases. It is more expressed after vestibular stimulation and predominates in the patients with TIA, where significant increase of the DBF was observed.
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10. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 1 , , ,

Clinical presentation includes transient ischemic attacks (TIA) or retinal ischemia so that typical manifestations of extracranial carotid stenosis include amaurosis fugax (transient blindness in one eye), unilateral paresis, unilateral sensory disturbances, aphasia, and dysarthria.
Clinical presentation includes transient ischemic attacks (TIA) or retinal ischemia so that typical manifestations of extracranial carotid stenosis include amaurosis fugax (transient blindness in one eye), unilateral paresis, unilateral sensory disturbances, aphasia, and dysarthria. It is important to note that development of symptoms and the severity of stenosis are not necessarily directly related, due to collateral circulation from the contralateral carotid artery and the posterior circulation.
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Strokes due to carotid stenosis may indicate a treatable asymptomatic lesion prior to the event, but majority of strokes (about 80%) are not preceded by a TIA or minor stroke and CEA or CAS can help to prevent these events.
Strokes due to carotid stenosis may indicate a treatable asymptomatic lesion prior to the event, but majority of strokes (about 80%) are not preceded by a TIA or minor stroke and CEA or CAS can help to prevent these events. It is useful to know that only about 11% strokes will occur in patients who suffer not previously announced stroke secondary to thromboembolism from asymptomatic ICA stenosis. Taking into account that CEA reduced the 5-year risk of stroke by about 50% [22,10] it can be concluded that only half of the 11% of strokes due to a previously asymptomatic stenosis could ever have been prevented (about 5% overall). However, it must be taken into account that up to half of all strokes that occur due to ACAS are not consequence of embolization from stenosis itself, but the most common are those of lacunar or cardioembolic origin [23]. Besides, number needed to treat (NNT) is 17 to 20 CEAs to prevent one stroke in five years.
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However, what is often not considered is that while disease progression has been reported to be associated with TIA or stroke, in at least 50% of cases this happened at the time of the event, rather than being evident before the stroke.
However, what is often not considered is that while disease progression has been reported to be associated with TIA or stroke, in at least 50% of cases this happened at the time of the event, rather than being evident before the stroke. Often it can happen that the CDS immediately before the stroke showed a ‘non-surgical’ stenosis (
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Features of unstable carotid plaque during and after the hyperacute period following TIA/stroke.
Salem MK, Sayers RD, Bown MJ, West K, Moore D, Robinson TG, Naylor AR. Features of unstable carotid plaque during and after the hyperacute period following TIA/stroke.
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11. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 2 , , ,

Posterior circulation disorders (PCD) include a) vertebrobasilar insufficiency (VВI) with different clinical manifestations: vestibulocerebellar syndrome, cephalgia, cochlear syndrome, vegetovascular dystonia, visual disturbances, “syndrome of vertebral artery compression", etc.; b) vertebrobasilar TIA; and c) stroke.
Posterior circulation disorders (PCD) include a) vertebrobasilar insufficiency (VВI) with different clinical manifestations: vestibulocerebellar syndrome, cephalgia, cochlear syndrome, vegetovascular dystonia, visual disturbances, “syndrome of vertebral artery compression", etc.; b) vertebrobasilar TIA; and c) stroke. All of them are caused by blood flow disturbances in vertebral (VA), basilar (ВA) and posterior cerebral arteries (PCA).
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EDS and TCCD are important tools for estimation of high hemodynamic risk patients with PCD and rotation induced vertebrobasilar ischemia, which predicts a possible posterior circulation TIA or stroke.
EDS and TCCD are important tools for estimation of high hemodynamic risk patients with PCD and rotation induced vertebrobasilar ischemia, which predicts a possible posterior circulation TIA or stroke. These methods help the proper selection of further treatment strategy.
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Vertebrobasilar stenosis predicts high early recurrent stroke risk in posterior circulation stroke and TIA.
Gulli G, Khan S, Markus HS. Vertebrobasilar stenosis predicts high early recurrent stroke risk in posterior circulation stroke and TIA.
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THE IMPORTANCE AND MANAGEMENT OF TIA-S
THE IMPORTANCE AND MANAGEMENT OF TIA-S
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About 20% of ischaemic strokes are closely preceded by a TIA.
About 20% of ischaemic strokes are closely preceded by a TIA. The classic definition of TIA based on time duration has been largely replaced by tissue rather than time, what points out the importance of early neuroimaging evaluation.
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The classic definition of TIA based on time duration has been largely replaced by tissue rather than time, what points out the importance of early neuroimaging evaluation.
About 20% of ischaemic strokes are closely preceded by a TIA. The classic definition of TIA based on time duration has been largely replaced by tissue rather than time, what points out the importance of early neuroimaging evaluation.
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The risk of stroke following TIA is highest in the first 48 hours.
The risk of stroke following TIA is highest in the first 48 hours. The most widely used prediction in risk assessment is the ABCD2 score, although it has been shown to have only modest predictive value. It is not accurate in predicting atrial fibrillation or large artery stenosis, what led to the introduction of ABCD3 and ABCD3-I, which are both superior in the prediction of short and long-term risk of stroke.
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Current guidelines recommend urgent management of patients with TIA, what can be done within specialized TIA clinics or even in the emergency departments, thus hospitalization is not necessary and reduction in up to 80% in hospital admission can be achieved.
Current guidelines recommend urgent management of patients with TIA, what can be done within specialized TIA clinics or even in the emergency departments, thus hospitalization is not necessary and reduction in up to 80% in hospital admission can be achieved.
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management, risk score, TIA.
management, risk score, TIA.
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12. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 1 , , ,

Of these, 21 (30%) had a transient retinal or cerebral ischemia (TIA), and 29 (41%) suffered from stroke (12 of them minor stroke, Rankin Scale score 1 or 2).
Of 71 eligible patients, 50 were symptomatic in the vascular territory of the middle cerebral artery (MCA) ipsilateral to the carotid artery pathology. Of these, 21 (30%) had a transient retinal or cerebral ischemia (TIA), and 29 (41%) suffered from stroke (12 of them minor stroke, Rankin Scale score 1 or 2). The symptomatic side was left in 40 cases (56%) and right in 31 (44%) cases. Patients with bilateral ICA high-grade changes were not included in the study. 21 (30%) patients with non-focal brain discirculation were defined as “asymptomatic” and were also enrolled.
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13. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 2 , , ,

All patients were followed prospectively and cardiovascular events, recurrent TIA/strokes or death were recorded.
Clinical and functional statuses were assessed with the NIHSS and the modified Rankin Scale (mRS), respectively, at discharge and at 1, 3, 6 months and yearly thereafter. All patients were followed prospectively and cardiovascular events, recurrent TIA/strokes or death were recorded. During the follow-up period, all selected patients with a suitable transtemporal acoustic window underwent a 60-minutes bilateral TCD monitoring of the middle cerebral artery in order to detect MES. The arteries were insonated at a mean depth of 54±4 mm using a low-frequency probe (1-3 MHz), fixed to a headframe, following a validated
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During follow-up, we observed a low TIA/ stroke recurrence rate (3/96, 3.1%), in agreement with many studies on cryptogenic stroke [10].
During follow-up, we observed a low TIA/ stroke recurrence rate (3/96, 3.1%), in agreement with many studies on cryptogenic stroke [10]. Interestingly though not statistically significant, 2 recurrent events occurred in the MES+ group compared to the MESpatients [6.2%, (2/32) vs. 1.6% (1/64), p=0.25]. The low number of events observed does not allow attributing a prognostic significance to the presence of MES.
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Countable and non-countable microembolic signals by TCD in first-ever stroke or TIA patients with PFO.
Telman G, Kouperberg E, Sprecher E, Yarnitsky D. Countable and non-countable microembolic signals by TCD in first-ever stroke or TIA patients with PFO.
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Size of PFO and amount of microembolic signals in patients with ischaemic stroke or TIA.
Telman G, Yalonetsky S, Kouperberg E, Sprecher E, Lorber A, Yarnitsky. Size of PFO and amount of microembolic signals in patients with ischaemic stroke or TIA.
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Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
Markus H, Cullinane M. Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
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The microembolic signals are accepted surrogate marker for future stroke risk and have been used to show treatment efficacy in different clinical conditions (TIA, carotid stenosis, carotid endarterectomy, coronary bypass surgery and during some intravascular interventions).
Transcranial Doppler (TCD) is also useful for evaluation of the efficacy of pharmacotherapy not only in subarachnoid bleeding but also in ischemic stroke risk patients. The microembolic signals are accepted surrogate marker for future stroke risk and have been used to show treatment efficacy in different clinical conditions (TIA, carotid stenosis, carotid endarterectomy, coronary bypass surgery and during some intravascular interventions). The randomized trials successfully evaluated the effect of different anticoagulants (e.g. heparin vs. LMWH), mono vs dual antiplatelet therapy in stroke or stroke risk patients.
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Микроемболичните сигнали се приемат като непряк маркер за бъдещ риск от инсулт и се използват за преценка на ефикасността от лечението при различни клинични състояния (TIA, каротидна стеноза, каротидна ендартеректомия, коронарен байпас и по време на някои интраваскуларни интервенции).
Положителният ефект на статините и антихипертензивните лекарства е доказан. Някои от тях водят до значително намаляване на дебелината на ИМК след 1-2 години терапия, а други нямат благоприятен ефект. По-голяма част от проучванията установяват значителна положителна връзка между намалената дебелина на ИМК и риска от съдови усложнения. Предимствата на тези проучвания на каротидния ИМК са: a/ оценява се ефекта на новите лекарства върху ИМК; б/ резултатите могат да бъдат решаващи за започване на продължително и скъпо струващо проучване на лекарства за атеросклероза, базирано на оценка заболеваемост-смъртност или за опровергаване на резултатите му. Транскраниалната доплерова сонография (ТДС) е полезен метод за оценка на ефикасността на фармакотерапията не само при пациенти със субарахноиден кръвоизлив, но и при тези с исхемичен мозъчен инсулт. Микроемболичните сигнали се приемат като непряк маркер за бъдещ риск от инсулт и се използват за преценка на ефикасността от лечението при различни клинични състояния (TIA, каротидна стеноза, каротидна ендартеректомия, коронарен байпас и по време на някои интраваскуларни интервенции). Рандомизирани проучвания успешно са оценили ефекта на различни антикоагуланти (напр. хепарин/нискомолекулни хепарини) или моно/двойна антитромбоцитна терапия при
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A case report with a dissection of the internal carotid artery (ICA) is a frequent cause of ischemic stroke (IS) or transitory ischemic attack (TIA) in young age is presented.
A case report with a dissection of the internal carotid artery (ICA) is a frequent cause of ischemic stroke (IS) or transitory ischemic attack (TIA) in young age is presented.
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The appropriate choice of diagnostic methods and therapeutic behavior in patients with dissection of the ICA is of great importance for the outcome of IS or TIA at young age.
The appropriate choice of diagnostic methods and therapeutic behavior in patients with dissection of the ICA is of great importance for the outcome of IS or TIA at young age.
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carotid dissection, ischemic stroke, TIA
carotid dissection, ischemic stroke, TIA
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14. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 15, 2019, No. 1 , , ,

– presence of thrombi and emboli due to atherosclerosis in 2/3 of patients, arterial hypertension, diabetes mellitus, carotid and coronary atherosclerosis, TIA or AIS, smoking, in patients
– presence of thrombi and emboli due to atherosclerosis in 2/3 of patients, arterial hypertension, diabetes mellitus, carotid and coronary atherosclerosis, TIA or AIS, smoking, in patients
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