Transient neurological attack

Template:Page 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."

In contract, for focal symptoms, see Transient ischemic attack.

## Contents

* 1 Etiology
* 2 Symptoms
* 3 Prognosis
* 4 References

## Etiology

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14% have acute stroke (diffusion-weighted imaging [DWI]–positive)[3]

## Symptoms

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The most common symptoms are:[4]

* Loss in consciousness (including syncope) or less commonly a decrease in consciousness
* Dizziness (not including vertigo)
* Amnesia
* Unsteadiness

Witness observations can add to diagnostic accuracy, especially in distinguishing epilepsy from syncope[5]. Witnesses are less able to help distinguish syncope from psychogenic nonepileptic seizures (PNES)[5].

## Prognosis

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Atypical neurologic symptoms increase the risk of stroke[6].

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).[4]

Rates of subsequent stroke and dementia after transient neurological attack[4] | 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[7][8]. If the patient truly has symptoms in both eyes, the patient's symptoms should be a homonymous hemianopsia visual field defect.[9]. If the symptoms are just in one eye, then the patient may have disease of the carotid or retinal artery causing amaurosis fugax.[10]
* Transient global amnesia is not a risk factor subsequent stroke.[11]
* Nonrotary dizziness may[12] or may not[7] be a risk factor for subsequent stroke.

## References

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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.CS1 maint: Multiple names: authors list (link)
2. ↑ "A classification and outline of cerebrovascular diseases. II". Stroke. 6 (5): 564–616. 1975. PMID 1179466.
3. ↑ Coutts SB, Moreau F, Asdaghi N, Boulanger JM, Camden MC, Campbell BCV et al. (2019) Rate and Prognosis of Brain Ischemia in Patients With Lower-Risk Transient or Persistent Minor Neurologic Events. JAMA Neurol ():. DOI:10.1001/jamaneurol.2019.3063 PMID: 31545347
4. ↑ 4.0 4.1 4.2 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.CS1 maint: Multiple names: authors list (link)
5. ↑ 5.0 5.1 Chen M, Jamnadas-Khoda J, Broadhurst M, Wall M, Grünewald R, Howell SJL; et al. (2019). "Value of witness observations in the differential diagnosis of transient loss of consciousness". Neurology. 92 (9): e895–e904. doi:10.1212/WNL.0000000000007017. PMID 30804064.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ Tuna, Maria A; Rothwell, Peter M (2021). "Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis". The Lancet. 397 (10277): 902–912. doi:10.1016/S0140-6736(20)31961-9. ISSN 0140-6736.
7. ↑ 7.0 7.1 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.
8. ↑ 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.CS1 maint: Multiple names: authors list (link)
9. ↑ 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.CS1 maint: Multiple names: authors list (link)
10. ↑ Gautier JC (1993). "Amaurosis fugax". N. Engl. J. Med. 329 (6): 426–8. PMID 8326979.
11. ↑ 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.CS1 maint: Multiple names: authors list (link)
12. ↑ 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.