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.

• Weakness

  On admission, muscle weakness in her left leg, lower left quadrantanopia and left lower extremity deep sensory disturbance were observed. Laboratory data showed no coagulopathy and autoimmune antibody was negative. [unboundmedicine.com]

  In some cases, people may only have weakness or clumsiness in their hand. [medicineonline.com]

  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 [symptoma.com]

  Presenting signs and symptoms of stroke by vascular distribution ARTERY CLINICAL FEATURES Anterior circulation ICA/MCA Ipsilateral monocular vision loss (amaurosis fugax) ±Contralateral weakness or sensory changes Contralateral weakness, sensory changes [thoracickey.com]

  Symptoms of stroke are Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) Sudden confusion, trouble speaking or understanding speech Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss [icdlist.com]

• Pain

  […] fibers → central pain-signaling system → pain. – Central sensitization of pain-signaling system. – Low-threshold mechanoreceptor input develops capacity to evoke pain. – With time, efferent sympathetic fibers develop capacity to activate nociceptor fibers [demosmedical.com]

  […] to improve cognitive impairments, such as problems with concentration, attention, memory, and poor judgment Help with obtaining assistive devices that promote independence Education and counseling Safety and independence measures and home care needs Pain [hopkinsmedicine.org]

  [Case Reports] Rinsho Shinkeigaku 2019; 59(5):268-273Wada T, Kitaguchi H, Shindo KRS A 61-year-old woman presented with acute intense lower back pain and weakness in her left leg. She also presented with throbbing headache on the same day. [unboundmedicine.com]

  This eye inflammation doesn’t cause a red or painful eye but still can cause reduced vision if it isn’t treated. This is why regular checks are important. Read more about JIA. [versusarthritis.org]

  Related factors include diminished strength and endurance, pain or discomfort, impaired mentation, neuromuscular disorder, depression, and anxiety. [medical-dictionary.thefreedictionary.com]

• Fever

  The causes of tachycardia include fever, pain, and dehydration that can be handled. If ICT increases in stroke patients, it usually occurs after the first day. [ncpnanda.top]

  […] if blood sugar >300 mg/dL. • Control of intracranial pressure (ICP): See following section. • Fever : Potentially damaging to the ischemic brain. – Antipyretics (e.g., acetaminophen) should be given early while the source of fever is being ascertained [demosmedical.com]

  Fever after subarachnoid hemorrhage: Risk factors and impact on outcome. Neurology 2007;68:1013-9. 47. Kurtz P, Schmidt JM, Claassen J, Carrera E, Fernandez L, Helbok R, et al. [asianjns.org]

  […] should be considered if other causes of TIA have not been found.[7][9] Differential diagnosis[edit] Diagnosis[7] Findings[7] Brain tumor Severe unilateral headache with nausea and vomiting Central nervous system infection (e.g., meningitis, encephalitis) Fever [en.wikipedia.org]

  The breakdown products of blood cause a chemical meningitis within several hours following the hemorrhage, which is manifested as nuchal rigidity and frequently a low-grade fever. [dartmouth.edu]

• Anemia

  People with carotid stenosis should also work closely with their healthcare providers to control other risk factors for stroke. semiannual screening of children with sickle cell anemia, using ultrasound to determine the child's risk of stroke treatment [medicineonline.com]

  Uncommonly, TIAs result from impaired perfusion due to severe hypoxemia, reduced oxygen-carrying capacity of blood (eg, profound anemia, carbon monoxide poisoning), or increased blood viscosity (eg, severe polycythemia), particularly in brain arteries [merckmanuals.com]

  Anemia is associated with metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage. Neurocrit Care 2010;13:10-6. 48. English SW, Fergusson D, Chassé M, Turgeon AF, Lauzier F, Griesdale D, et al. [asianjns.org]

  • Systemic diseases associated with hypercoagulable states : – Elevated RBC count, hematocrit, fibrinogen – Protein S and C deficiencies – Sickle-cell anemia – Cancer • Hyperlipidemia: Several clinical trials have shown a reduction in stroke with use [demosmedical.com]

• Weight Loss

  Initial weight loss Extrapolation onset Maximum weight Material temperature temperature (a) loss temperature ([degrees]C) Rind outer layer 182 228 368 Rind middle layer 188 235 373 Rind inner layer 187 231 372 Rind node 186 227 373 Southern pine 213 321 [medical-dictionary.thefreedictionary.com]

  OBESITY • All patients with TIA or stroke should be screened for obesity with measurement of BMI (Class I; Level of Evidence C). • Given the demonstrated beneficial effects of weight loss on cardiovascular risk factors, the usefulness of weight loss among [slideshare.net]

• Vomiting

  Headaches may be associated with photophobia, nausea and vomiting. Focal neurological deficits can occur, secondary to ischemia or convexity subarachnoid hemorrhage. CSF studies are normal or near normal. [radiopaedia.org]

  The headache may be accompanied by nausea, vomiting, intolerance to light and noise, and an altered mental status. [emsworld.com]

  […] speech impairments, including slurred speech or difficulty finding the correct word difficulty doing math or writing visual impairments difficulty understanding speech or writing inability to recognize family members or common objects dizziness nausea or vomiting [medicineonline.com]

  Headache, vomiting, and decreased level of consciousness are somewhat more common with hemorrhagic stroke, but ischemic stroke can occur with similar symptoms, especially if the vertebrobasilar arterial system is involved or if a hemispheric stroke is [thoracickey.com]

  Coma/LOC, unusual vomiting, occipital HA, vertigo, inability to sit, stand, or walk, eyes deviate to opposite side (ipsilateral CN6 palsy), dysarthria, dysphagia. 5. Lobar (cerebral) hemorrhage: HA and vomiting. [demosmedical.com]

• Nausea

  Headaches may be associated with photophobia, nausea and vomiting. Focal neurological deficits can occur, secondary to ischemia or convexity subarachnoid hemorrhage. CSF studies are normal or near normal. [radiopaedia.org]

  […] body speech impairments, including slurred speech or difficulty finding the correct word difficulty doing math or writing visual impairments difficulty understanding speech or writing inability to recognize family members or common objects dizziness nausea [medicineonline.com]

  […] and vomiting Central nervous system infection (e.g., meningitis, encephalitis) Fever, headache, confusion, neck stiffness, nausea, vomiting, photophobia, change in mental status Falls/trauma Headache, confusion, bruising Hypoglycemia Confusion, weakness [en.wikipedia.org]

  The headache may be accompanied by nausea, vomiting, intolerance to light and noise, and an altered mental status. [emsworld.com]

  If nausea and vomiting with associated occipital headache and ataxia precede cranial nerve dysfunction and depression of consciousness in a hypertensive patient, it is important to consider cerebellar hemorrhage because it may be surgically remediable [dartmouth.edu]

• Stroke

  Abstract 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]

  |Completed stroke (disorder)|Extension of cerebrovascular accident|Extension of cerebrovascular accident (disorder)|Extension of stroke|Inferior cerebellar artery syndrome|Ischaemic stroke|Ischaemic stroke without coma|Ischemic stroke|Ischemic stroke [averbis.com]

  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]

  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]

• Aphasia

  We report the case of a 58-year-old woman with depression and hypertension in whom aphasia, right-sided hemiparesis, and a possible right visual field defect were identified during recovery from right unilateral electroconvulsive therapy (ECT). [ncbi.nlm.nih.gov]

  Thus, a great variety of manifestations have been observed in different cases, including transient hemiplegia, hemianopsia, monoplegia, aphasia, paresthesia, localized convulsive phenomena, etc. It is well known that a given patient FULL TEXT [annals.org]

  MIT may be useful in patients with nonfluent (Broca’s) aphasia. [demosmedical.com]

  A TIA may cause sudden dimming or loss of vision ( amaurosis fugax ), aphasia, slurred speech ( dysarthria ) and mental confusion. But unlike a stroke, the symptoms of a TIA can resolve within a few minutes or within 24 hours. [glendaleneuroclinic.com]

  Common stroke symptoms include the loss of balance or coordination; dizziness; slurred speech; aphasia; paralysis, numbness, or weakness on one side of the body; blurred, double, or blackened vision; and sudden, severe headache. [fortherecordmag.com]

• Neck Stiffness

  Cardiac imaging can be performed if head and neck imaging do not reveal a vascular cause for the patient's TIA (such as atherosclerosis of the carotid artery or other major vessels of the head and neck). [en.wikipedia.org]

• Irritability

  – With a SAH, blood is irritating, causing severe HA that is classically described as “worst HA of my life.” – Sudden, transient LOC in 20% to 45% at onset. – Focal neurologic deficits include CN3 or CN6 palsy (from direct pressure from the aneurysm [demosmedical.com]

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.

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]

The benefit of endarterectomy in 50-69% stenoses decreases, and individual predictors of the operation risk are useful for choosing the appropriate treatment. [ncbi.nlm.nih.gov]

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]

Abstract 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]

Publication Details First-Page Preview 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 [karger.com]

However, not all TIAs and minor strokes have the same prognosis. [academic.oup.com]

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]

The infectious etiology of chronic rheumatic diseases. Semin Arthritis Rheum. 1987 Aug;17(1):1–23. [PubMed] [Google Scholar] Schachter J. Chlamydial infections (third of three parts). N Engl J Med. 1978 Mar 9;298(10):540–549. [ncbi.nlm.nih.gov]

Infectology (71) Gastroenterology and Hepatology (66) Pharmacology (62) Emergency Medicine (55) Respiratory Medicine (55) Biophysics (53) Histology, Embryology (51) Anatomy (50) Endocrinology, Metabolism (48) Microbiology (45) Obstetrics, Gynaecology (44) Epidemiology [portal.mefanet.cz]

Epidemiological impact in the United States of a tissue-based definition of transient ischemic attack. Stroke. 2003; 34: 919–924.LinkGoogle Scholar 33 Saver JL, Albers GW, Easton JD, for the TIA Working Group. [ahajournals.org]

Morgenstern EPIDEMIOLOGY AND USUAL CAUSES OF CEREBROVASCULAR DISEASE Stroke is a clinical syndrome characterized by rapidly developing signs or symptoms, or both, of focal neurologic dysfunction with no obvious cause other than vascular origin. [thoracickey.com]

Feigin VL, Lawes CM, Bennett DA, Anderson CS (2003) Stroke epidemiology: a review of population-based studies of incidence, prevalence, and casefatality in the late 20th century. [link.springer.com]

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]

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]

This article provides a historical perspective on the evolution of the definition of TIA and reviews the associated pathophysiology and symptoms. [medscape.com]

Internal Medicine (380) Physiology and Pathophysiology (297) Paediatrics, Neonatology (287) Cardiology, Angiology (263) Pathology and Forensic Medicine (215) Medical Chemistry and Biochemistry (159) Genetics (127) Surgery, Traumatology and Orthopaedics [portal.mefanet.cz]

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]

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]

We administer clopidogrel (75 mg daily) if dipyridamole and aspirin are not indicated, have caused adverse effects, or did not prevent ocular or cerebral ischemic events. [ncbi.nlm.nih.gov]

This may prevent another TIA or a stroke. Preventing another TIA or stroke Your treatment will also focus on preventing another TIA or stroke. [healthlinkbc.ca]

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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