[Etiology and treatment of cerebral ischemia at the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital.].

Objectives: This is the first Icelandic study in which the etiology of cerebral ischemia is examined. The goal of the study was to examine how the etiology of cerebral infarcts and transient ischemic attacks was determined at the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital and how the patients were treated.

Material And Methods: The study was retrospective and included 102 patients with cerebral infarcts and transient ischemic attacks that were admitted to the Department of Neurology and Rehabilitation Medicine at Reykjavik City Hospital in 1994. Patients with cerebral hemorrhage were excluded. The patients' mean age was 68.5 years (range 25-89) and the male:female ratio was 59:43. Cerebral computerized tomography was obtained from 98 (98%) patients. Carotid ultrasonography was done in 72 (72%) cases and carotid angiogram in 14 (14%) patients. Transthoracic echocardiography was done in 69 (69%) cases and transesophagal echocardiography in the 11 (11%) youngest patients.

Results: Of the 102 patients, 79 (79%) had cerebral infarctions and 23 (23%) transient ischemic attacks. The probable cause of cerebral infarction was cardioembolic in 21 patients (27%), lacunar infarction in 16 patients (20%) and carotid artery disease in 13 patients (16%). In 37% of the cases the cause was unspecific. The etiology of transient ischemic attacks was carotid artery disease in four patients (17%), cardioembolic in two patients (9%) and lacunar in one patient (4%). In 70% of the cases the cause of transient ischemic attacks was undetermined. Nine of the 102 patients (9%) underwent carotid endarterectomy and 15 (15%) were treated with warfarin.

Conclusion: A specific etiology was found in 2/3 of those with cerebral infarcts and in 1/3 of those with transient ischemic attacks. Determination of etiology led to specific preventive treatment in 1/4 of the patients.