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Reversible Ischemic Neurologic Deficit

RIND

Reversible ischemic neurological deficit is a type of stroke due to the occlusion of blood supply to the brain leading to ischemia and neurological deficits which recover from 24 hours and up to a few weeks. It should be differentiated from a transient ischemic attack in which the neurological deficits do not last longer than a day. However, currently the term reversible ischemic neurological deficit is rarely used.


Presentation

Reversible ischemic neurological deficit (RIND) is defined as a stroke due to ischemic brain injury with weakness, paresis/paralysis, speech abnormalities, etc which last from anywhere between a day to 21 days followed by either a complete recovery or residual deficits. Loeb et al [1] described the following clinical presentation in RIND:

  • rare condition with an incidence of less than 5% amongst all strokes
  • commonly occurs in the territory of the internal carotid artery with almost 70% occlusion of the artery
  • is of sudden onset
  • loss of consciousness is rare
  • there are no specific imaging findings
  • arteriography often shows arterial occlusion
  • is associated with a poor prognosis and death in patients with massive hemorrhagic infarcts.

The clinical features may completely dissipate if thrombolysis is performed soon after the formation of the thrombus [1].

RIND indicates a tiny brain stroke with recovery within a few weeks and should be differentiated from a transient ischemic attack (TIA), which is associated with a reversal of symptoms within twenty-four hours. Currently, the term "RIND" is not used commonly [2] as the diagnosis is based on tissue appearance on imaging studies rather than on the duration of the symptoms.

Coronary Artery Disease
  • artery disease in addition to atrial fibrillation.[en.wikipedia.org]
  • . • Heart disease: – Congestive heart failure (CHF) and coronary artery disease (CAD) increase risk by twofold. – Valvular heart disease and arrhythmias increase risk of embolic stroke. • Atrial fibrillation (AF): Fivefold increased risk (Wolf et al.,[demosmedical.com]
Vietnamese
  • Claus ( German ), Vangelis Katsoulas ( Greek ), Roberto Marchesi ( Italian ), Robin van der Vliet ( Esperanto ), Reno Rake ( Indonesian ), Nahuel Rodríguez ( Spanish ), Gao Pan ( Chinese ), Hoài Sang Lăng ( Vietnamese ) EUdict is online since May 9, 2005[eudict.com]
Turkish
  • Falzon – author of the English-Maltese dictionary András Tuna – for smart suggestions about improving this site Interface translation : Tomislav Kuzmić ( Croatian ), Vasudevan Tirumurti, Fahim Razick ( Tamil ), Matti Tapanainen ( Finnish ), Ebru Bağlan ( Turkish[eudict.com]
Pulse Deficit
Stroke
  • The benefit of carotid endarterectomy (CE) in preventing recurrent stroke and improving survival in the patient who has sustained a reversible ischemic neurologic deficit (RIND) or stroke is still controversial.[ncbi.nlm.nih.gov]
  • Doppler testing of the internal carotid arteries is important to diagnose carotid artery stenosis as strokes can be associated with up to 70% stenosis.[symptoma.com]
  • In 368 patients operated on for transient ischemic attacks alone, the operative stroke rate was 1.6%. Stump pressure and EEG are unreliable indicators of cerebral perfusion during carotid endarterectomy in patients who have suffered stroke or RIND.[ncbi.nlm.nih.gov]
  • The probability of subsequent ischemic stroke or RIND was six times greater in patients with RIND than in a normal age- and sex-matched population.[ncbi.nlm.nih.gov]
  • Since a TIA is a short-term type of stroke, the risk factors for stroke apply to TIAs as well. The American Heart Association has recently issued guidelines for stroke prevention.[medicineonline.com]

Workup

The diagnosis of RIND is based on a thorough history, physical, neuropsychiatric, and cognitive evaluation along with laboratory and imaging studies. History should elicit the onset, duration, and progress of the neurological deficits as well as a history of co-morbid factors like hypertension, diabetes, etc.

Laboratory tests include complete blood count, blood sugar levels, lipid profile and other tests indicated by clinical presentation. An electrocardiogram may show evidence of cardiac conduction anomalies and while echocardiography may reveal the source of the thrombus and cardiac function. Doppler testing of the internal carotid arteries is important to diagnose carotid artery stenosis as strokes can be associated with up to 70% stenosis.

Currently, the features of the brain tissue on imaging studies like high-resolution computed tomography (HRCT) and diffusion-weighted magnetic resonance imaging (MRI) rather than the time (duration) of deficits is used to detect the condition [2]. CT scans can demonstrate hemorrhage while MRI can detect even tiny infarctions. Several reports indicate that there are very few differences between TIAs and RIND on imaging studies [3] with extracranial abnormalities appearing identical in patients with TIAs, RIND and minor strokes [4] [5]. This suggests that the three types of strokes differ quantitatively but not qualitatively and are therefore regarded as a continuation of the same pathological process [6] [7]. The infarcts are usually of the lacunar type in all three groups with RIND patients having small deep infarcts [8]. Arteriography may help to identify the occlusive thrombus in these patients.

Treatment

  • Prompt recognition of cerebrovascular events is important to prevent complications such as cerebral edema, seizures, and aspiration, as well as to use new treatments for stroke.[ncbi.nlm.nih.gov]
  • Handbook of Stroke, Second Edition is a user-friendly one-stop guide to the clinical management of patients with cerebrovascular disorders—from clinical and laboratory assessment, differential diagnosis, and initial management, to medical and surgical treatment[books.google.com]
  • Treatment & Monitoring What are the treatments for the condition? Most people with transient ischemic attacks are treated right away with aspirin and then with blood thinners if they do not have bleeding into the brain.[medicineonline.com]
  • Access the comprehensive, expert clinical guidance you need to recognize the clinical manifestations of stroke, use the latest laboratory and imaging studies to arrive at a diagnosis, and generate an effective medical and surgical treatment plan.[books.google.com]
  • The effects were not significantly different among treatment groups. Forty milligrams of acetylsalicylic acid seemed to have less platelet-inhibitory effect.[ncbi.nlm.nih.gov]

Prognosis

  • This study defines the incidence, prevalence, and long-term prognosis of 120 patients with reversible ischemic neurologic deficit (RIND) in the population of Rochester, Minnesota.[ncbi.nlm.nih.gov]
  • […] occurs in the territory of the internal carotid artery with almost 70% occlusion of the artery is of sudden onset loss of consciousness is rare there are no specific imaging findings arteriography often shows arterial occlusion is associated with a poor prognosis[symptoma.com]
  • Stroke, Second Edition is a user-friendly one-stop guide to the clinical management of patients with cerebrovascular disorders—from clinical and laboratory assessment, differential diagnosis, and initial management, to medical and surgical treatment, prognosis[books.google.com]
  • Michael O'Fallon First published May 1, 1982, DOI: Abstract This study defines the incidence, prevalence, and long-term prognosis of 120 patients with reversible is chemic neurologic deficit (RIND) in the population of Rochester, Minnesota.[neurology.org]
  • Abstract A hospital-based series of 712 patients with either transient ischemic attacks (TIAs) or reversible ischemic neurologic deficits (RINDs) was followed prospectively for 4 years in order to determine the long-term prognosis for cerebral and cardiac[karger.com]

Etiology

  • Etiology Risk factors for TIA are the same as those for ischemic stroke.[merckmanuals.com]
  • Reversible ischemic neurologic deficit (RIND) Reversible ischemic neurologic deficit (RIND) is similar to a TIA in etiology.[emsworld.com]
  • Right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction).[icd10data.com]
  • Events may be classified by arterial distribution, temporal pattern, or etiology (e.g., embolic vs. thrombotic).[fpnotebook.com]

Epidemiology

  • Chapter 37: pathogenesis, classification, and epidemiology of cerebrovascular disease. In: Rowland LP, Pedley TA, eds. Merritt’s Neurology . 12 th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.[demosmedical.com]
  • The patient's age is the most reliable risk factor in predicting any level of carotid stenosis in transient ischemic attack. [36] Epidemiology [ edit ] With the difficulty in diagnosing a TIA due to its nonspecific symptoms of neurologic dysfunction at[en.wikipedia.org]
  • Clinical and epidemiologic aspects of vertebrobasilar and nonfocal cerebral ischemia. In: Berguer R, Bauer RB, editors. Vertebrobasilar arterial occlusive disease. New York: Raven Press; 1984 b . p. 27 –36.[academic.oup.com]
  • Nonetheless, epidemiological studies have clearly shown an association between low prevalence of atherosclerosis and vascular events in populations eating more whole grains, vegetables, and fruit.[dartmouth.edu]
Sex distribution
Age distribution

Pathophysiology

  • Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke.[books.google.com]
  • It is suggested that TIAs, including AF, and RIND should be regarded as separate entities from a pathophysiological and clinical point of view.[ncbi.nlm.nih.gov]
  • These anatomical and clinical studies were remarkable enough but the real breakthrough in investigating cerebral pathophysiology and in devis ing appropriate corrective neurosurgical procedures had to await the re markable advances in technology of the[books.google.com]
  • A consistent format for each care plan allows faster lookup of topics, with headings for Overview/Pathophysiology, Health Care Setting, Assessment, Diagnostic Tests, Nursing Diagnoses, Desired Outcomes, Interventions with Rationales, and Patient-Family[books.google.com]
  • Pathophysiology : Of patients presenting with a stroke, 85% will have sustained a cerebral infarction due to inadequate blood flow to part of the brain, and the remainder will have had an intracerebral hemorrhage.[oasisdiscussions.ca]

Prevention

  • Prompt recognition of cerebrovascular events is important to prevent complications such as cerebral edema, seizures, and aspiration, as well as to use new treatments for stroke.[ncbi.nlm.nih.gov]
  • This edition includes cutting-edge information on acute stroke treatment, cerebrovascular disease genetics, primary stroke prevention, management of unruptured intracranial aneurysms, and the newest therapies for various stroke-related symptoms and disorders[books.google.com]
  • The benefit of carotid endarterectomy (CE) in preventing recurrent stroke and improving survival in the patient who has sustained a reversible ischemic neurologic deficit (RIND) or stroke is still controversial.[ncbi.nlm.nih.gov]
  • Stay up to date on hot topics such as mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more.[books.google.com]
  • Prevention & Expectations What can be done to prevent the condition? Transient ischemic attacks can be minimized by addressing known risk factors for stroke.[medicineonline.com]

References

Article

  1. Loeb C, Priano A, Alabano C. Strokes with full recovery. In: Meyer JS, Lechner H, Reivich M, Eichorn O, editors. Cerebral Vascular Disease. Stuttgart: Georg Thieme. 1973: 15-21.
  2. Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009;40:2276–2293.
  3. Calandre L, Gomara S, Bermejo F, et al. Clinical CT correlations in TIA, RIND, and Strokes with minimum residuum. Stroke. 1984; 15: 4: 663-666.
  4. Olsson JE, Muller R, Bemeli S. Long-term anticoagulant therapy for TIAs and minor strokes with minimum residuum. Stroke 1976; 4: 444- 451
  5. Bardin JA, Bernstein EF, Humber PB, et al. Is Carotid endarterectomy beneficial in prevention of recurrent stroke? Arch Surg 1982; 117: 1401-140
  6. Ladurner G, Sager WD, Iliff LD, Lechner H. A correlation of clinical findings and CT in ischemic cerebrovascular disease. Eur Neurol 1979;18:281-8.
  7. Barnett HJM. Stroke prevention. In: Ross Russell RW, ed. Vascular diseases of the nervous system. Edinburgh 1983; 405-27.
  8. Koudstaal PJ, van Gijn J, Frenken CWGM, et al. TIA, RIND, minor stroke: a continuum, or different subgroups? Journal of Neurology and Psychiatry. 1992; 55:95-97

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Last updated: 2018-06-21 17:18