The past decade has witnessed an explosion in both the breadth and depth of computer utilization in all developed countries. Most U.S. installations are hard-pressed simply to keep themselves aware ...of new hardware and software, much less to play any active role in the always exciting area of applications development. Universities feel this burden with special sensitivity due to their traditional dual roles of education and research. Not as visible, but nonetheless critical, are the needs associated with the effective administration of a modern university complex. Pushed on by a strong sense of professional responsibility and pulled into the whirlwind by an increasingly demanding user base, educational centers have typically responded by simply placing themselves into motion, hoping to satisfy requirements due to action itself. Many such actions have been next to useless and have led to frustration among all involved parties. It is mandatory that a sense of direction be maintained during any period of rapid change; the alternative is Brownian motion.
All patients (1,328) suspected of having transient ischemic attacks (TIA) who came to six institutions over a 21-months period were identified. Each case was reviewed by a neurological investigator, ...and a definite diagnosis of TIA was supported in 39% and ruled out in 30%. The reliability of the neurologist's review diagnosis was assessed by three methods, and close agreement (84% to 93%) was obtained. Factors demonstrated to effect the diagnosis were historical information, neurological training of the examiners, type of symptom complex, presence of carotid artery bruits, and examination during an attack.
To better understand transient ischemic attacks (TIA), all patients (1,328) with TIA-like symptoms were identified at six participating institutions representing known variations in geography, ...referral patterns, and socioeconomic status. A total of 954 patients were observed for a mean of 14.3 months. Problems in diagnosis are defined, demographic information is summarized, and features of the histroy, examination, tests, and treatments are noted.
Angiographic procedures were carried out on 36% of 1,328 patients suspected of having transient ischemic attacks (TIA). Among six participating centers, this ranged from 13% to 82%. This large ...difference might be related to the number of patients considered good surgical candidates and differences in the use of screening noninvasive diagnostic techniques. Arch studies, using catheter techniques, were performed most often. Although 13% of the patients had transient complications, permanent neurological deficits occurred in only 0.65%. Angiographic lesions were best correlated to clinical symptoms in those patients thought to definitely have carotid artery system TIA but were commonly seen in all other groups. Thus, clinical correlation was poor.
A total of 969 (73%) of 1,328 patients with cases of suspected transient ischemic attacks (TIAs) who came to six institutions during a 21-month period were followed up. Factors were identified and ...prospectively analyzed for risk for further TIAs, stroke, and deatn. A history of multiple carotid artery TIAs was significantly related to further TIAs. A single TIA placed the patient at greater risk for early infarction. Older age, male sex, and unreliability to take dangerous medication were risk factors for cerebral infarction. Anticoagulant therapy, older age, male sex, diabetes mellitus, heart disease, abnormal ECG, and poor surgical risk were factors for death. The increased mortality associated with anticoagulants was confined to the older age group. While white patients treated with antiplatelet-aggregating agents had a lower mortality than those treated otherwise, this was not true amont black patients.
Variations in therapy for patients with complaints suggesting transient ischemic attacks (TIAs) among six participating medical centers are described. Selected treatment, based on clinical ...interpretation of patient characteristics, varied widely among centers. Therefore, results cannot be attributed to specific treatment. Nevertheless, there was little difference between treatment categories and the likelihood of further TIAs. The mortality of the patients who had received anticoagulants was significantly higher (P less than .001) than those patients receiving other treatment. Possible reasons for these differences are discussed.
All patients (1,328) suspected of having transient ischemic attacks (TIA) who came to six institutions during a 21-month period were identified. Symptoms and symptom complexes were related to the ...clinical diagnoses by cross-tabulation, factor analysis, and discriminant analysis. The diagnoses obtained by the discriminant analysis program were comparable to those of reviewing clinical neurologists. Symptoms of importance in the vertebral-basilar system (VBS) were bilateral visual blurring, diplopia, ataxia, and dizziness; In either carotid system (CAS), ipsilateral monocular visual disturbance anc contralateral weakness or sensory complaints; in the left CAS, language disturbances; and in those whose ultimate diagnosis was not TIA, loss of consciousness, confusion, and bilateral leg weakness. Patients with VBS TIAs have symptoms common to conditions that are not TIA and have a greater variety of symptoms and more combinations of symptoms than CAS TIA.
Examination during an episode of transient ischemic attack (TIA) was performed on 121 of 1,307 patients suspected of having a single type of TIA. This examination supported the diagnosis of TIA in 79 ...patients and contributed to the establishment of a diagnosis other than TIA in 42. Although the examination increased diagnostic reliability, it did not always result in a definite diagnosis. The most common neurologic findings during a TIA were weakness of an arm or side of the face. Important findings not suggested by history included visual defects and blood pressure fluctuation. Also unexpected were the absence of findings such as sensory deficits in the presence of sensory complaints, retinal emboli, and cardiac abnormalities. Severe arteriosclerotic disease was less evident, the attacks were longer and more severe, and monocular blindness was rare.
