Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan.
Eur J Neurol. 2021 Feb;28(2):509-515. doi: 10.1111/ene.14550. Epub 2020 Oct 18.
A transient ischemic attack (TIA) can occur without self-awareness of symptoms. We aimed to investigate characteristics of patients with a tissue-based diagnosis of TIA but having no self-awareness of their symptoms and whose symptoms were witnessed by bystanders.
We used data from the multicenter registry of 1414 patients with a clinical diagnosis of TIA. For patients without evidence of ischemic lesions on imaging, clinical characteristics were compared between patients with and without self-awareness of their TIA symptoms.
Among 896 patients (559 men, median age of 70 years), 59 (6.6%) were unaware of their TIA symptoms, but had those symptoms witnessed by bystanders. Patients without self-awareness of symptoms were older and more frequently female, and more likely to have previous history of stroke, premorbid disability, and atrial fibrillation, but less likely to have dyslipidemia than those with self-awareness. Patients without self-awareness of symptoms arrive at hospitals earlier than those with self-awareness (P < 0.001). ABCD score was higher in patients without self-awareness of symptoms than those with self-awareness (median 5 vs. 4, P = 0.002). Having no self-awareness of symptoms was a significant predictor of ischemic stroke within 1 year after adjustment for sex, ABCD score, and onset to arrival time (hazard ratio = 2.44, 95% confidential interval: 1.10-4.83), but was not significant after further adjustment for arterial stenosis or occlusion.
Patients with a TIA but having no self-awareness of their symptoms might have higher risk of subsequent ischemic stroke rather than those with self-awareness, suggesting urgent management is needed even if patients have no self-awareness of symptoms.
短暂性脑缺血发作（TIA）可在无自觉症状的情况下发生。我们旨在研究那些有组织学诊断为 TIA 但对其症状无自觉，且其症状由旁观者见证的患者的特征。
我们使用了来自 1414 例 TIA 临床诊断患者的多中心登记数据。对于影像学无缺血性病灶的患者，我们比较了有和无 TIA 症状自觉的患者之间的临床特征。
在 896 例患者（559 例男性，中位年龄 70 岁）中，有 59 例（6.6%）对其 TIA 症状无自觉，但这些症状被旁观者看到。无症状自觉的患者年龄较大，更常为女性，且更有可能有既往卒中史、病前残疾和心房颤动，但血脂异常的可能性低于有症状自觉的患者。无症状自觉的患者比有症状自觉的患者更早到达医院（P<0.001）。无症状自觉的患者 ABCD 评分高于有症状自觉的患者（中位数 5 分比 4 分，P=0.002）。在调整性别、ABCD 评分和发病至到达时间后，无症状自觉是 1 年内发生缺血性卒中的显著预测因素（危险比=2.44，95%置信区间：1.10-4.83），但在进一步调整动脉狭窄或闭塞后则不再显著。
对其症状无自觉的 TIA 患者可能比有自觉的患者有更高的后续缺血性卒中风险，这表明即使患者对症状无自觉，也需要紧急管理。
