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| | #REDIRECT [[Transient neurological attack]] |
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| ==Classification==
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| ===Focal===
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| {{main|Transient ischemic attack}}
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| ===Nonfocal===
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| Nonfocal transient neurological attack is defined as:<ref name="pmid9099194">{{cite journal |author=Bots ML, van der Wilk EC, Koudstaal PJ, Hofman A, Grobbee DE |title=Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance |journal=Stroke |volume=28 |issue=4 |pages=768–73 |year=1997 |pmid=9099194 |doi=|url=http://stroke.ahajournals.org/cgi/content/full/28/4/768}}</ref><ref name="pmid1179466">{{cite journal |author= |title=A classification and outline of cerebrovascular diseases. II |journal=Stroke |volume=6 |issue=5 |pages=564–616 |year=1975 |pmid=1179466 |doi=|url=http://stroke.ahajournals.org/cgi/reprint/6/5/564}}</ref>
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| :"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."
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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>
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| *Loss in consciousness (including [[syncope]]) or less commonly a decrease in consciousness
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| *[[Dizziness]] (not including [[vertigo]])
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| *[[Amnesia]]
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| *Unsteadiness
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| Witness observations can add to diagnostic accuracy, especially in distinguishing epilepsy from syncope<ref name="pmid30804064">{{cite journal| author=Chen M, Jamnadas-Khoda J, Broadhurst M, Wall M, Grünewald R, Howell SJL et al.| title=Value of witness observations in the differential diagnosis of transient loss of consciousness. | journal=Neurology | year= 2019 | volume= 92 | issue= 9 | pages= e895-e904 | pmid=30804064 | doi=10.1212/WNL.0000000000007017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30804064 }} </ref>. Witnesses are less able to help distinguish syncope from psychogenic nonepileptic seizures (PNES)<ref name="pmid30804064"/>.
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| ==Prognosis==
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| 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>
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| {| class="wikitable" align="right"
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| |+ Rates of subsequent stroke and dementia after transient neurological attack<ref name="pmid18159057"/>
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| ! rowspan="2"| !!rowspan="2"| [[Stroke]]!!colspan="2" |[[Dementia]]
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| |-
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| | align="center"|Any||align="center"|Vascular
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| | Focal attacks<br/>([[transient ischemic attack]]s)||align="center"| 2.14||align="center"| 0.94||align="center"|1.12
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| |-
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| | Nonfocal attacks||align="center"|1.56||align="center"|1.59||align="center"|4.97
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| |-
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| | Mixed attacks||align="center"|2.48||align="center"|3.46||align="center"|18.8
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| |}
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| Among nonfocal symptoms:
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| * [[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 [[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>
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| * [[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>
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| * 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.
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| ==References==
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| <references/>
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