Editors' ChoiceStroke

Tackling TIA

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Science Translational Medicine  26 Oct 2011:
Vol. 3, Issue 106, pp. 106ec171
DOI: 10.1126/scitranslmed.3003336

Transient ischemic attacks (TIAs) are tiny, elusive strokes. Symptoms can come and go within hours, and there may be no objective evidence of vascular disease on radiology films. This diagnostic uncertainty presents problems in providing the best care for the patient. Since having a bona fide TIA indicates that a patient is at high risk for a subsequent stroke, timely interventions are imperative. Zhan et al. tackled this problem by measuring blood levels of RNA for many genes in a case control study of a small human cohort. Of 52 patients, half had TIAs and half had other vascular risk factors but no symptoms. (TIA diagnosis was made by a board-certified neurologist and defined as “an acute loss of focal cerebral or ocular function of vascular etiology lasting less than 24 hours.”) Among the 449 genes evaluated, two clusters were identified that were not explained by demographic factors such as age, gender, and presence of chronic medical conditions (such as hypertension, diabetes, smoking, atrial fibrillation). Using forward selection linear discriminate analysis, the authors found that 34 gene probes distinguished patients with TIAs from control subjects with 100% sensitivity and 100% specificity.

The patterns of gene expression in patients with TIAs were significantly involved with immune function and coagulation. With further investigation, these TIA-associated genes could serve as therapeutic targets to reduce future stroke risk or as biomarkers for TIA. Either way, these genetic markers may have diagnostic importance and represent a breakthrough in tackling the challenging clinical uncertainty around TIA diagnosis.

X. Zhan et al., Transient ischemic attacks characterized by RNA profiles in blood. Neurology 12 October 2011 (10.1212/WNL.0b013e318236eee6). [Abstract]

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