Transient neurological attack
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Classification
Focal
Nonfocal
Nonfocal transient neurological attack is defined as:[1][2]
- "disturbances of vision in one or both eyes consisting of flashes, objects, distorted-view tunnel vision, or image moving on change of posture; alteration of muscle strength consisting of tiredness or heavy sensation in one or more limbs, either unilateral or bilateral; sensory symptoms alone (unilateral or bilateral) or a gradual spread of sensory symptoms; brain stem symptoms and coordination difficulties consisting of isolated disorder of swallowing or articulation, double vision, dizziness, or uncoordinated movements; and accompanying symptoms including unconsciousness, limb jerking, tingling of the limbs or lips, disorientation, and amnesia."
The most common symptoms are:[3]
- Loss in consciousness (including syncope) or less commonly a decrease in consciousness
- Dizziness (not including vertigo)
- Amnesia
- Unsteadiness
Prognosis
In a cohort study of 6062 adults about 5% had a TNA over 10 years found rates of subsequent stroke and dementia were increased depending on type of transient neurological attack (see table).[3]
| Stroke | Dementia | ||
|---|---|---|---|
| Any | Vascular | ||
| Focal attacks (transient ischemic attacks) |
2.14 | 0.94 | 1.12 |
| Nonfocal attacks | 1.56 | 1.59 | 4.97 |
| Mixed attacks | 2.48 | 3.46 | 18.8 |
Among nonfocal symptoms:
- Vision disorders such as blurring or dimming may portend a subsequent stroke[4][5]. If the patient truly has symptoms in both eyes, the patient's symptoms should be a homonymous hemianopsia visual field defect.[6]. If the symptoms are just in one eye, then the patient may have disease of the carotid or retinal artery causing amaurosis fugax.[7]
- Transient global amnesia is not a risk factor subsequent stroke.[8]
- Nonrotary dizziness may[9] or may not[4] be a risk factor for subsequent stroke.
References
- ↑ Bots ML, van der Wilk EC, Koudstaal PJ, Hofman A, Grobbee DE (1997). "Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance". Stroke 28 (4): 768–73. PMID 9099194. [e]
- ↑ (1975) "A classification and outline of cerebrovascular diseases. II". Stroke 6 (5): 564–616. PMID 1179466. [e]
- ↑ 3.0 3.1 3.2 Bos MJ, van Rijn MJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM (2007). "Incidence and Prognosis of Transient Neurological Attacks". JAMA 298 (24): 2877–2885. DOI:10.1001/jama.298.24.2877. PMID 18159057. Research Blogging.
- ↑ 4.0 4.1 Evans JG (1990). "Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and non-rotatory dizziness". Age Ageing 19 (1): 43–9. PMID 2316424. [e]
- ↑ Dennis MS, Bamford JM, Sandercock PA, Warlow CP (1989). "Lone bilateral blindness: a transient ischaemic attack". Lancet 1 (8631): 185–8. DOI:10.1016/S0140-6736(89)91203-8. PMID 2563098. Research Blogging.
- ↑ Pessin MS, Kwan ES, DeWitt LD, Hedges TR, Gale D, Caplan LR (1987). "Posterior cerebral artery stenosis". Ann. Neurol. 21 (1): 85–9. DOI:10.1002/ana.410210115. PMID 3827217. Research Blogging.
- ↑ Gautier JC (1993). "Amaurosis fugax". N. Engl. J. Med. 329 (6): 426–8. PMID 8326979. [e]
- ↑ Pantoni L, Bertini E, Lamassa M, Pracucci G, Inzitari D (2005). "Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study". Eur. J. Neurol. 12 (5): 350–6. DOI:10.1111/j.1468-1331.2004.00982.x. PMID 15804264. Research Blogging.
- ↑ Heyman A, Wilkinson W, Pfeffer R, Vogt T. 'Dizzy' spells in the elderly—a predictor of stroke? Tram Am Neurol Assoc 1980; 105:169-71.