Lavallée Philippa C, Sissani Leila, Labreuche Julien, Meseguer Elena, Cabrejo Lucie, Guidoux Céline, Klein Isabelle F, Touboul Pierre-Jean, Amarenco Pierre
From the INSERM U 1148 and Paris-Diderot University, Sorbonne Paris Cité, France (P.C.L., L.S., J.L., E.M., L.C., C.G., I.F.K., P.-J.T., P.A.); and Department of Neurology and Stroke Centre (P.C.L., L.S., E.M., L.C., C.G., P.-J.T., P.A.) and Department of Radiology (I.F.K.), Bichat University Hospital, Paris, France.
Stroke. 2017 Jun;48(6):1495-1500. doi: 10.1161/STROKEAHA.117.016743. Epub 2017 May 9.
Contrary to typical transient symptoms (TS), atypical TS, such as partial sensory deficit, dysarthria, vertigo/unsteadiness, unusual cortical visual deficit, and diplopia, are not usually classified as symptoms of transient ischemic attack when they occur in isolation, and their clinical relevance is frequently denied.
Consecutive patients with recent TS admitted in our transient ischemic attack clinic (2003-2008) had systematic brain, arterial, and cardiac investigations. We compared the prevalence of recent infarction on brain imaging, major investigational findings (symptomatic intracranial or extracranial atherosclerotic stenosis ≥50%, cervical arterial dissection, and major source of cardiac embolism), and 1-year risk of major vascular events in patients with isolated typical or atypical TS and nonisolated TS, after exclusion of the main differential diagnoses.
Among 1850 patients with possible or definite ischemic diagnoses, 798 (43.1%) had isolated TS: 621 (33.6%) typical and 177 (9.6%) atypical. Acute infarction on brain imaging was similar in patients with isolated atypical and typical TS but less frequent than in patients with nonisolated TS, observed in 10.0%, 11.5%, and 15.3%, respectively (<0.0001). Major investigational findings were found in 18.1%, 26.4%, and 26.3%, respectively (=0.06). One-year risk of a major vascular events was not significantly different in the 3 groups.
Transient ischemic attack diagnosis should be considered and investigated in patients with isolated atypical TS.
与典型短暂性症状（TS）不同，非典型TS，如部分感觉缺失、构音障碍、眩晕/不稳、异常皮质视觉缺失和复视，单独出现时通常不被归类为短暂性脑缺血发作的症状，其临床相关性也常被否定。
在我们的短暂性脑缺血发作门诊（2003 - 2008年）收治的近期TS连续患者接受了系统的脑部、动脉和心脏检查。在排除主要鉴别诊断后，我们比较了孤立性典型或非典型TS患者与非孤立性TS患者脑成像上近期梗死的患病率、主要检查结果（症状性颅内或颅外动脉粥样硬化狭窄≥50%、颈动脉夹层和心脏栓塞的主要来源）以及1年主要血管事件风险。
在1850例可能或确诊为缺血性疾病的患者中，798例（43.1%）有孤立性TS：621例（33.6%）为典型TS，177例（9.6%）为非典型TS。孤立性非典型和典型TS患者脑成像上的急性梗死情况相似，但比非孤立性TS患者少见，分别为10.0%、11.5%和15.3%（<0.0001）。主要检查结果分别在18.1%、26.4%和26.3%的患者中发现（=0.06）。三组患者1年主要血管事件风险无显著差异。
对于孤立性非典型TS患者应考虑并进行短暂性脑缺血发作的诊断及检查。
