National Hospital for Neurology and Neurosurgery, Box 6, Queen Square, London WC1N 3BG, United Kingdom.
Stroke. 2012 Sep;43(9):2324-30. doi: 10.1161/STROKEAHA.112.657759. Epub 2012 Jul 12.
Transient focal neurological episodes (TFNE) are recognized in cerebral amyloid angiopathy (CAA) and may herald a high risk of intracerebral hemorrhage (ICH). We aimed to determine their prevalence, clinical neuroimaging spectrum, and future ICH risk.
This was a multicenter retrospective cohort study of 172 CAA patients. Clinical, imaging, and follow-up data were collected. We classified TFNE into: predominantly positive symptoms ("aura-like" spreading paraesthesias/positive visual phenomena or limb jerking) and predominantly negative symptoms ("transient ischemic attack-like" sudden-onset limb weakness, dysphasia, or visual loss). We pooled our results with all published cases identified in a systematic review.
In our multicenter cohort, 25 patients (14.5%; 95% confidence interval, 9.6%-20.7%) had TFNE. Positive and negative symptoms were equally common (52% vs 48%, respectively). The commonest neuroimaging features were leukoaraiosis (84%), lobar ICH (76%), multiple lobar cerebral microbleeds (58%), and superficial cortical siderosis/convexity subarachnoid hemorrhage (54%). The CAA patients with TFNE more often had superficial cortical siderosis/convexity subarachnoid hemorrhage (but not other magnetic resonance imaging features) compared with those without TFNE (50% vs 19%; P=0.001). Over a median period of 14 months, 50% of TFNE patients had symptomatic lobar ICH. The meta-analysis showed a risk of symptomatic ICH after TFNE of 24.5% (95% confidence interval, 15.8%-36.9%) at 8 weeks, related neither to clinical features nor to previous symptomatic ICH.
TFNE are common in CAA, include both positive and negative neurological symptoms, and may be caused by superficial cortical siderosis/convexity subarachnoid hemorrhage. TFNE predict a high early risk of symptomatic ICH (which may be amenable to prevention). Blood-sensitive magnetic resonance imaging sequences are important in the investigation of such episodes.
短暂性局灶性神经发作（TFNE）在脑淀粉样血管病（CAA）中被识别，并可能预示着颅内出血（ICH）的高风险。我们旨在确定其患病率、临床神经影像学谱和未来的 ICH 风险。
这是一项针对 172 例 CAA 患者的多中心回顾性队列研究。收集了临床、影像学和随访数据。我们将 TFNE 分为：主要阳性症状（“类先兆”扩散性感觉异常/阳性视觉现象或肢体抽搐）和主要阴性症状（“类短暂性脑缺血发作”突发肢体无力、构音障碍或视力丧失）。我们将我们的结果与系统评价中确定的所有已发表病例进行了汇总。
在我们的多中心队列中，25 例患者（14.5%；95%置信区间，9.6%-20.7%）出现 TFNE。阳性和阴性症状同样常见（分别为 52%和 48%）。最常见的神经影像学特征是脑白质疏松症（84%）、脑叶 ICH（76%）、多发性脑叶微出血（58%）和皮质下脑铁沉积症/脑凸面蛛网膜下腔出血（54%）。与无 TFNE 的 CAA 患者相比，有 TFNE 的患者更常出现皮质下脑铁沉积症/脑凸面蛛网膜下腔出血（但不是其他磁共振成像特征）（50%比 19%；P=0.001）。在中位数为 14 个月的随访期间，50%的 TFNE 患者发生症状性脑叶 ICH。荟萃分析显示，TFNE 后发生症状性 ICH 的风险为 24.5%（95%置信区间，15.8%-36.9%），发生在 8 周时，与临床特征或先前的症状性 ICH 无关。
TFNE 在 CAA 中很常见，包括阳性和阴性神经系统症状，可能由皮质下脑铁沉积症/脑凸面蛛网膜下腔出血引起。TFNE 预测早期发生症状性 ICH 的风险较高（可能可预防）。血液敏感磁共振成像序列在这些发作的检查中很重要。
