Philippa C Lavallée1, Leila Sissani2, Julien Labreuche2, Elena Meseguer2, Lucie Cabrejo2, Céline Guidoux2, Isabelle F Klein2, Pierre-Jean Touboul2, Pierre Amarenco2. 1. From the INSERM U 1148 and Paris-Diderot University, Sorbonne Paris Cité, France (P.C.L., L.S., J.L., E.M., L.C., C.G., I.F.K., P.-J.T., P.A.); and Department of Neurology and Stroke Centre (P.C.L., L.S., E.M., L.C., C.G., P.-J.T., P.A.) and Department of Radiology (I.F.K.), Bichat University Hospital, Paris, France. philippalavallee@yahoo.fr. 2. From the INSERM U 1148 and Paris-Diderot University, Sorbonne Paris Cité, France (P.C.L., L.S., J.L., E.M., L.C., C.G., I.F.K., P.-J.T., P.A.); and Department of Neurology and Stroke Centre (P.C.L., L.S., E.M., L.C., C.G., P.-J.T., P.A.) and Department of Radiology (I.F.K.), Bichat University Hospital, Paris, France.
Abstract
BACKGROUND AND PURPOSE: Contrary to typical transient symptoms (TS), atypical TS, such as partial sensory deficit, dysarthria, vertigo/unsteadiness, unusual cortical visual deficit, and diplopia, are not usually classified as symptoms of transient ischemic attack when they occur in isolation, and their clinical relevance is frequently denied. METHODS: Consecutive patients with recent TS admitted in our transient ischemic attack clinic (2003-2008) had systematic brain, arterial, and cardiac investigations. We compared the prevalence of recent infarction on brain imaging, major investigational findings (symptomatic intracranial or extracranial atherosclerotic stenosis ≥50%, cervical arterial dissection, and major source of cardiac embolism), and 1-year risk of major vascular events in patients with isolated typical or atypical TS and nonisolated TS, after exclusion of the main differential diagnoses. RESULTS: Among 1850 patients with possible or definite ischemic diagnoses, 798 (43.1%) had isolated TS: 621 (33.6%) typical and 177 (9.6%) atypical. Acute infarction on brain imaging was similar in patients with isolated atypical and typical TS but less frequent than in patients with nonisolated TS, observed in 10.0%, 11.5%, and 15.3%, respectively (P<0.0001). Major investigational findings were found in 18.1%, 26.4%, and 26.3%, respectively (P=0.06). One-year risk of a major vascular events was not significantly different in the 3 groups. CONCLUSIONS: Transient ischemic attack diagnosis should be considered and investigated in patients with isolated atypical TS.
BACKGROUND AND PURPOSE: Contrary to typical transient symptoms (TS), atypical TS, such as partial sensory deficit, dysarthria, vertigo/unsteadiness, unusual cortical visual deficit, and diplopia, are not usually classified as symptoms of transient ischemic attack when they occur in isolation, and their clinical relevance is frequently denied. METHODS: Consecutive patients with recent TS admitted in our transient ischemic attack clinic (2003-2008) had systematic brain, arterial, and cardiac investigations. We compared the prevalence of recent infarction on brain imaging, major investigational findings (symptomatic intracranial or extracranial atherosclerotic stenosis ≥50%, cervical arterial dissection, and major source of cardiac embolism), and 1-year risk of major vascular events in patients with isolated typical or atypical TS and nonisolated TS, after exclusion of the main differential diagnoses. RESULTS: Among 1850 patients with possible or definite ischemic diagnoses, 798 (43.1%) had isolated TS: 621 (33.6%) typical and 177 (9.6%) atypical. Acute infarction on brain imaging was similar in patients with isolated atypical and typical TS but less frequent than in patients with nonisolated TS, observed in 10.0%, 11.5%, and 15.3%, respectively (P<0.0001). Major investigational findings were found in 18.1%, 26.4%, and 26.3%, respectively (P=0.06). One-year risk of a major vascular events was not significantly different in the 3 groups. CONCLUSIONS: Transient ischemic attack diagnosis should be considered and investigated in patients with isolated atypical TS.
Authors: Francisco Purroy; Mikel Vicente-Pascual; Gloria Arque; Robert Begue; Joan Farre; Yhovany Gallego; Maria Pilar Gil-Villar; Gerard Mauri; Nuria Montalà; Cristina Pereira; Coral Torres-Querol; Daniel Vazquez-Justes Journal: Front Neurol Date: 2022-07-14 Impact factor: 4.086