Transient neurological attack: Difference between revisions

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==Classification==
==Classification==
===Focal===
===Focal===
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The most common symptoms are:<ref name="pmid18159057">{{cite journal |author=Bos MJ, van Rijn MJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM |title=Incidence and Prognosis of Transient Neurological Attacks |journal=JAMA |volume=298 |issue=24 |pages=2877–2885 |year=2007 |pmid=18159057 |doi=10.1001/jama.298.24.2877}}</ref>
The most common symptoms are:<ref name="pmid18159057">{{cite journal |author=Bos MJ, van Rijn MJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM |title=Incidence and Prognosis of Transient Neurological Attacks |journal=JAMA |volume=298 |issue=24 |pages=2877–2885 |year=2007 |pmid=18159057 |doi=10.1001/jama.298.24.2877}}</ref>
*Loss in consciousness ([[syncope]]), or less commonly a decrease in consciousness
*Loss in consciousness (including [[syncope]]) or less commonly a decrease in consciousness
*[[Dizziness]] (not including [[vertigo]])
*[[Dizziness]] (not including [[vertigo]])
*[[Amnesia]]
*[[Amnesia]]
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==Prognosis==
==Prognosis==
In a cohort study of 6062 adults about 5% had a TNA over 10 years found rate of subsequent stroke was increased depending on type of transient neurological attack:<ref name="pmid18159057">{{cite journal |author=Bos MJ, van Rijn MJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM |title=Incidence and Prognosis of Transient Neurological Attacks |journal=JAMA |volume=298 |issue=24 |pages=2877–2885 |year=2007 |pmid=18159057 |doi=10.1001/jama.298.24.2877}}</ref>
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).<ref name="pmid18159057">{{cite journal |author=Bos MJ, van Rijn MJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM |title=Incidence and Prognosis of Transient Neurological Attacks |journal=JAMA |volume=298 |issue=24 |pages=2877–2885 |year=2007 |pmid=18159057 |doi=10.1001/jama.298.24.2877}}</ref>
*Focal attacks([[Transient ischemic attack]]s) - risk is increased by 2.14
{| class="wikitable" align="right"
*Nonfocal attacks - 1.56
|+ Rates of subsequent stroke and dementia after transient neurological attack<ref name="pmid18159057"/>
*Mixed attacks - 2.48
! rowspan="2"|&nbsp;!!rowspan="2"| [[Stroke]]!!colspan="2" |[[Dementia]]
 
|-
Among nonfocal symptoms, other studies have found increase rate of subsequent stroke for after symptoms of blurring or dimming of vision<ref name="pmid2316424">{{cite journal |author=Evans JG |title=Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and non-rotatory dizziness |journal=Age Ageing |volume=19 |issue=1 |pages=43–9 |year=1990 |pmid=2316424 |doi=}}</ref><ref name="pmid2563098">{{cite journal |author=Dennis MS, Bamford JM, Sandercock PA, Warlow CP |title=Lone bilateral blindness: a transient ischaemic attack |journal=Lancet |volume=1 |issue=8631 |pages=185–8 |year=1989 |pmid=2563098 |doi=}}</ref>.
| align="center"|Any||align="center"|Vascular
|-
| Focal attacks<br/>([[transient ischemic attack]]s)||align="center"| 2.14||align="center"| 0.94||align="center"|1.12
|-
| Nonfocal attacks||align="center"|1.56||align="center"|1.59||align="center"|4.97
|-
| Mixed attacks||align="center"|2.48||align="center"|3.46||align="center"|18.8
|}


Among nonfocal symptoms, other studies have ''not'' found increase rate of subsequent stroke for after symptoms of transient global amnesia<ref name="pmid15804264">{{cite journal |author=Pantoni L, Bertini E, Lamassa M, Pracucci G, Inzitari D |title=Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study |journal=Eur. J. Neurol. |volume=12 |issue=5 |pages=350–6 |year=2005 |pmid=15804264 |doi=10.1111/j.1468-1331.2004.00982.x}}</ref> or nonrotary dizziness<ref name="pmid2316424"/>.
Among nonfocal symptoms:
* [[Vision disorder]]s such as blurring or dimming may portend a subsequent [[stroke]]<ref name="pmid2316424">{{cite journal |author=Evans JG |title=Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and non-rotatory dizziness |journal=Age Ageing |volume=19 |issue=1 |pages=43–9 |year=1990 |pmid=2316424 |doi=|url=http://ageing.oxfordjournals.org/cgi/reprint/19/1/43}}</ref><ref name="pmid2563098">{{cite journal |author=Dennis MS, Bamford JM, Sandercock PA, Warlow CP |title=Lone bilateral blindness: a transient ischaemic attack |journal=Lancet |volume=1 |issue=8631 |pages=185–8 |year=1989 |pmid=2563098 |doi=10.1016/S0140-6736(89)91203-8}}</ref>. If the patient truly has symptoms in both eyes, the patient's symptoms should be a [[Hemianopsia|homonymous hemianopsia]] visual field defect.<ref name="pmid3827217">{{cite journal |author=Pessin MS, Kwan ES, DeWitt LD, Hedges TR, Gale D, Caplan LR |title=Posterior cerebral artery stenosis |journal=Ann. Neurol. |volume=21 |issue=1 |pages=85–9 |year=1987 |pmid=3827217 |doi=10.1002/ana.410210115}}</ref>. If the symptoms are just in one eye, then the patient may have disease of the carotid or retinal artery causing ''[[amaurosis fugax]]''.<ref name="pmid8326979">{{cite journal |author=Gautier JC |title=Amaurosis fugax |journal=N. Engl. J. Med. |volume=329 |issue=6 |pages=426–8 |year=1993 |pmid=8326979 |doi=|url=http://content.nejm.org/cgi/content/full/329/6/426}}</ref>
* [[Transient global amnesia]] is ''not'' a risk factor subsequent stroke.<ref name="pmid15804264">{{cite journal |author=Pantoni L, Bertini E, Lamassa M, Pracucci G, Inzitari D |title=Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study |journal=Eur. J. Neurol. |volume=12 |issue=5 |pages=350–6 |year=2005 |pmid=15804264 |doi=10.1111/j.1468-1331.2004.00982.x}}</ref>
* Nonrotary [[dizziness]] may<ref>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.</ref> or may not<ref name="pmid2316424"/> be a risk factor for subsequent stroke.


==References==
==References==
<references/>
<references/>


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Classification

Focal

For more information, see: Transient ischemic attack.

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]

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]

Rates of subsequent stroke and dementia after transient neurological attack[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:

References

  1. ↑ 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]
  2. ↑ (1975) "A classification and outline of cerebrovascular diseases. II". Stroke 6 (5): 564–616. PMID 1179466. [e]
  3. ↑ 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. ↑ 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]
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Gautier JC (1993). "Amaurosis fugax". N. Engl. J. Med. 329 (6): 426–8. PMID 8326979. [e]
  8. ↑ 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.
  9. ↑ 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.
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