Nonfocal Symptoms in Patients with Transient Ischemic Attack and Association with Stroke Risk

Abstract

Background and Objective: Patients with transient ischemic attack（TIA）occasionally showed nonfocal symptoms, such as decreased consciousness, amnesia and non-rotatory dizziness. This study intended to evaluate the effect of nonfocal symptoms on the prognosis of patients with TIA. Methods: Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The predictive outcome was stroke occurrence at 1 year. Cumulative risks of stroke in patients with and without nonfocal symptoms were estimated with Kaplan-Meier models. Results: We studied 1384 patients with TIA (842 men; mean age, 56±13 years), including 450 (32.5%) with nonfocal symptoms. In the first year after TIA, stroke occurred in 168（12.1%） patients. There was no difference in the risk of stroke between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (11.8% vs 12.4%, log-rank; P=0.691). Conclusions: The occurrence of nonfocal symptoms did not increase the risk of stroke at one-year follow-up compared to the occurrence of focal symptoms alone.

Unconsciousness as the main nonfocal symptom of anterior circulation transient ischemic attack: A case report

“…[ 17 ] A previous study reported that the risk of stroke was similar in patients with or without nonfocal symptoms. [ 5 ] Our patient exhibited new cerebral infarction lesions on DWI following the second and third TIA episodes, wherein nonfocal symptoms, including unconsciousness, were observed along with some focal symptoms. Consequently, the diagnosis was updated from TIA to acute cerebral infarction, aligning with the new “tissue-based” definition of TIA.…”

“…[ 7 ] Notably, almost one-third of TIA patients also experience nonfocal symptoms, including reduced consciousness, confusion, nonrotatory dizziness, and unsteadiness; however, TIA diagnosis primarily hinges on the sudden onset of focal neurological symptoms, such as aphasia, dysarthria, hemiparesis/hemiplegia, and facial paralysis. [ 4 , 5 ] Moreover, non-rotatory dizziness, paresthesia, and amnesia are the most commonly seen nonfocal symptoms of TIA. [ 7 ] Transient LOC (TLOC) is defined as a state of real or apparent LOC with loss of awareness, characterized by amnesia for the period of unconsciousness, abnormal motor control, loss of responsiveness, and a short duration.…”

“…[ 5 ] However, nonfocal symptoms in TIA patients, such as unconsciousness, are more common in the posterior circulation than in the anterior circulation. [ 5 ] Furthermore, Toshiya Ishihara et al reported that TIA patients with nonfocal symptoms were more likely to show lesions in the posterior circulation on diffusion-weighted imaging (DWI) and vascular examination than those without nonfocal symptoms, and vascular lesions in the posterior circulation were independently associated with nonfocal symptoms. [ 4 ] Unconsciousness in TIA may be caused by transient ischemia of the bilateral hemisphere or brain stem.…”

“…[4] There is no difference in the risk of stroke between patients with and without nonfocal symptoms. [5] However, nonfocal symptoms in Written informed consent was obtained from the patient to publish this case report and any accompanying images.…”