일과성 허혈발작

Affected area

Signs and symptoms

Implications

Cranial nerves

Visual loss in one or both eyes

Bilateral loss may indicate more ominous onset of brainstem ischemia.

Double vision

If double vision is subtle, the patient may describe it as "blurry" vision.

Vestibular dysfunction

True vertigo is likely to be described as a spinning sensation rather than nonspecific lightheadedness.

Difficulty swallowing

Trouble swallowing may indicate brainstem involvement; if the swallowing problem is severe, there may be an increased risk of aspiration.

Motor function

Unilateral or bilateral weakness affecting the face, arm, or leg

Bilateral signs may indicate more ominous onset of brainstem ischemia.

Sensory function

Unilateral or bilateral: either decreased sensation (numbness) or increased sensation (tingling, pain) in the face, arm, leg, or trunk

Sensory function If sensory dysfunction occurs without other signs or symptoms, the prognosis may be more benign, but recurrence is high.

Speech and language

Slurring of words or reduced verbal output; language difficulty pronouncing, comprehending, or "finding" words

If speech is severely slurred or facial drooling is excessive, there is an increased risk of aspiration.
Writing and reading also may be impaired.

Coordination

Clumsy arms, legs, or trunk; loss of balance or falling (particularly to one side) with standing or walking

Incoordination of limbs, trunk, or gait may indicate cerebellar or brainstem ischemia.

Psychiatric or cognitive function

Apathy or inappropriate behavior

These symptoms can indicate frontal lobe involvement and frequently are misinterpreted as poor volitional cooperation.

Excessive somnolence

This symptom may indicate bilateral hemispheric or brainstem involvement.

Agitation or psychosis

Rarely, these symptoms may indicate brainstem ischemia, particularly if they occur in association with cranial nerve or motor dysfunction.

Confusion or memory changes

These rarely are isolated symptoms; more frequently, they are associated with language, motor, sensory, or visual changes.

Inattention to surrounding environment, particularly to one side; if severe, patient may deny deficit or even his or her own body parts.

Depending on the severity of neglect, the physician may need to lift the patient's arm to check for strength, rather than rely on the patient to perform this task.

Context
- Management of patients with acute transient ischemic attack (TIA) varies widely, with some institutions admitting all patients and others proceeding with outpatient evaluations.
- Defining the short-term prognosis and risk factors for stroke after TIA may provide guidance in determining which patients need rapid evaluation.
Objective
- To determine the short-term risk of stroke and other adverse events after emergency department (ED) diagnosis of TIA.
Design and Setting
- Cohort study conducted from March 1997 through February 1998 in 16 hospitals in a health maintenance organization in northern California.
Patients
- A total of 1707 patients (mean age, 72 years) identified by ED physicians as having presented with TIA.
Main Outcome
- Measures
  - Risk of stroke during the 90 days after index TIA; other events, including death, recurrent TIA, and hospitalization for cardiovascular events.
Results
- During the 90 days after index TIA, 180 patients (10.5%) returned to the ED with a stroke, 91 of which occurred in the first 2 days. Five factors were independently associated with stroke:
  1. age greater than 60 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.7; P = .01),
  2. diabetes mellitus (OR, 2.0; 95% CI, 1.4-2.9; P<.001),
  3. symptom duration longer than 10 minutes (OR, 2.3; 95% CI, 1.3-4.2; P = .005),
  4. weakness (OR, 1.9; 95% CI, 1.4-2.6; P<.001), and
  5. speech impairment (OR, 1.5; 95% CI, 1.1-2.1; P = .01).
- Stroke or other adverse events occurred in 428 patients (25.1%) in the 90 days after the TIA and included 44 hospitalizations for cardiovascular events (2.6%), 45 deaths (2.6%), and 216 recurrent TIAs (12.7%).
Conclusions
- Our results indicate that the short-term risk of stroke and other adverse events among patients who present to an ED with a TIA is substantial.
- Characteristics of the patient and the TIA may be useful for identifying patients who may benefit from expeditious evaluation and treatment.
http://jama.ama-assn.org/cgi/content/full/284/22/2901