Koudstaal P J, Algra A, Pop G A, Kappelle L J, van Latum J C, van Gijn J
Department of Neurology, University Hospital Rotterdam Dijkzigt, The Netherlands.
Lancet. 1992 Sep 12;340(8820):630-3. doi: 10.1016/0140-6736(92)92170-k.
Proposed guidelines for the diagnosis of transient ischaemic attack (TIA) involve interpretation of symptoms, so it can be very difficult to distinguish a TIA from other disorders, such as migraine, epilepsy, syncope, or neurosis. Atypical cerebral and visual events may be classified as TIA. To see whether TIA or stroke patients with atypical cerebral or visual symptoms are at high or low risk of cardiac complications, we prospectively followed 572 patients (entered into the Dutch multicentre TIA trial) with a diagnosis of TIA or minor ischaemic stroke, but whose symptoms did not fully accord with internationally accepted criteria. We compared their outcome with that of 2555 other TIA or stroke patients in the trial, who had unequivocal symptoms; all patients were treated with aspirin. During mean follow-up of 2.6 years the risk of a major vascular event did not differ between the groups (14.5% in patients with atypical symptoms vs 15.1% of patients with typical attacks). Patients with atypical attacks had a lower risk of stroke (5.6% vs 9.4%, hazard ratio 0.6, 95% confidence interval 0.4-0.9) and a higher risk of a major cardiac event (8.4% vs 5.9%, 1.4, 1.0-2.0) than did patients with typical attacks. These differences could not be explained by differences in cardiac risk factors, and were independent of minor discrepancies in baseline characteristics between the groups. A heavy or tired feeling in one or two limbs was the only atypical symptom associated with cerebral rather than cardiac events (ratio cardiac/cerebral events 0.8). For all other atypical symptoms cardiac events were about twice as common as cerebral events (range 1.3-2.5). Our findings suggest that TIA or minor stroke patients with atypical symptoms may have symptomatic heart disease, especially cardiac arrhythmia.
短暂性脑缺血发作（TIA）的诊断拟议指南涉及症状解读，因此很难将TIA与其他疾病区分开来，如偏头痛、癫痫、晕厥或神经症。非典型的脑部和视觉事件可能被归类为TIA。为了了解有非典型脑部或视觉症状的TIA或中风患者发生心脏并发症的风险是高还是低，我们前瞻性地随访了572例诊断为TIA或轻度缺血性中风但症状不完全符合国际公认标准的患者（纳入荷兰多中心TIA试验）。我们将他们的结局与该试验中另外2555例有明确症状的TIA或中风患者的结局进行了比较；所有患者均接受阿司匹林治疗。在平均2.6年的随访期间，两组发生重大血管事件的风险没有差异（非典型症状患者为14.5%，典型发作患者为15.1%）。与典型发作患者相比，非典型发作患者中风风险较低（5.6%对9.4%，风险比0.6，95%置信区间0.4 - 0.9），发生重大心脏事件的风险较高（8.4%对5.9%，1.4，1.0 - 2.0）。这些差异无法用心脏危险因素的差异来解释，并且独立于两组基线特征的微小差异。一两个肢体沉重或疲劳感是唯一与脑部而非心脏事件相关的非典型症状（心脏/脑部事件比例为0.8）。对于所有其他非典型症状，心脏事件的发生率约为脑部事件的两倍（范围为1.3 - 2.5）。我们的研究结果表明，有非典型症状的TIA或轻度中风患者可能患有症状性心脏病，尤其是心律失常。
