Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of transient ischemic attack of hemodynamic origin induced by postprandial hypotension

Hirokuni Sakima, M.D., Ph.D.1), Katsunori Isa, M.D., Ph.D.1), Koh Nakachi, M.D.1), Kanako Shiroma, M.D.1), Takashi Tokashiki, M.D., Ph.D.1) and Yusuke Ohya, M.D., Ph.D.1)

1)Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus Graduate School of Medicine

An 82-year-old man had a transient ischemic attack (TIA) with symptoms of consciousness disturbance and right hemiparesis while resting in a sitting position after breakfast. His symptoms improved around 1 h after onset when he lied in a supine position and received intravenous hydration. Duplex carotid ultrasonography revealed severe stenosis of the left common carotid artery. A decrease in the brain perfusion reserve was confirmed by acetazolamide-stress brain perfusion scintigraphy. Moreover, ambulatory blood pressure monitoring revealed a reduction in systolic blood pressure below 90 mmHg after each meal, indicating postprandial hypotension (PPH). The PPH was improved by oral administration of α-glucosidase inhibitor without any subsequent recurrences of TIA. The patient was diagnosed with TIA of hemodynamic origin that was induced by PPH and exhibited severe carotid stenosis. PPH is common in elderly people, and it should be recognized as a significant trigger for ischemic cerebrovascular disease.
Full Text of this Article in PDF (2518K)

(CLINICA NEUROL, 54: 162|165, 2014)
key words: postprandial hypotension, transient ischemic attack, α glucosidase inhibitor, ambulatory blood pressure monitoring

(Received: 23-Apr-13)