By Matthew Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a consultant for Procter & Gamble.

SOURCE: Lavallee PC, Sissani L, Labreuche J, et al. Clinical significance of isolated atypical transient symptoms in a cohort with transient ischemic attack. Stroke 2017;48:1495-1500. doi: 10.1161/STROKEAHA.117.016743.

Atypical transient symptoms, such as partial sensory deficit, dysarthria, vertigo and unsteadiness, unusual visual deficits, and diplopia, usually are not classified as transient ischemic attacks, and they frequently are not investigated in the same fashion. Investigators undertook detailed evaluation of these patients admitted to their TIA clinic from 2003 until 2008, and investigated them with systematic brain, arterial, and cardiac investigations. They compared the prevalence of recent brain infarction on imaging, as well as evidence of intracranial or extracranial atherosclerosis, cervical artery dissection, or a source of cardiac embolism. They then quantified the one-year risk of major vascular events in patients who had isolated typical or atypical transient symptoms.

Among 1,850 patients with possible ischemic diagnoses, 43% had isolated transient symptoms, with 34% being typical TIAs and 9.6% being atypical. The presence of brain infarction on imaging was similar in both groups of patients. One-year risk of recurrent major vascular events was not significantly different between patients who had typical TIA symptoms or atypical isolated or non-isolated symptoms. Therefore, these patients should be investigated intensively in a manner similar to patients with classical TIA symptoms.