Transient focal cerebral ischemia as a presenting manifestation of unruptured cerebral aneurysms.

Few reports have described an association between cerebral transient ischemic attacks (TIAs) and unruptured cerebral aneurysms. This study presents seven patients with TIA who had aneurysms in a vascular distribution appropriate to their clinical symptoms. In three patients, angiographic evidence of embolization was present distal to the aneurysm without apparent cardiac or extracranial arterial source for the emboli. The most reasonable pathogenesis for TIA in a patient with an associated saccular aneurysm would be thrombosis of the aneurysmal sac with subsequent embolization. However, subarachnoid blood can cause permanent focal intracranial narrowing, and this appeared to be a factor in at least one patient. The results imply that patients with symptoms of TIA should have their intracranial arterial circulation visualized as part of the diagnostic evaluation.