Ippen Franziska Maria, Walter Fabian, Hametner Christian, Gumbinger Christoph, Nagel Simon, Purrucker Jan C, Mundiyanapurath Sibu
Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
Front Neurol. 2021 Feb 15;12:644223. doi: 10.3389/fneur.2021.644223. eCollection 2021.
Transient ischemic attack (TIA) needs further diagnostic evaluation to prevent future ischemic stroke. However, prophylaxis can be harmful in elderly if the diagnosis is wrong. We aimed at characterizing differences in TIA mimics in younger and older patients to enhance diagnostic accuracy in elderly patients. In a dedicated neurological emergency room (nER) of a tertiary care University hospital, patients with transient neurological symptoms suspicious of TIA (<24 h) were retrospectively analyzed regarding their final diagnoses and their symptoms. These parameters were compared between patients aged 18-70 and >70 years using descriptive, univariable, and multivariable statistics. From November 2018 until August 2019, 386 consecutive patients were included. 271 (70%) had cardiovascular risk factors and all patients received cerebral imaging, mostly CT [376 (97%)]. There was no difference in the rate of diagnosed TIA between the age groups [85 (46%) vs. 58 (39%); = 0.213].TIA mimics in the elderly were more often internal medicine diseases [35 (19%) vs. 7 (5%); < 0.001] and epileptic seizures [48 (26%) vs. 24 (16%); = 0.032] but less often migraine [2 (1%) vs. 20 (13%); < 0.001]. The most frequent symptoms in all patients were aphasia and dysarthria [107 (28%) and 92 (24%)]. Sensory impairments were less frequent in elderly patients [23 (11%) vs. 54 (30%); < 0.001]. Impaired consciousness and orientation were independent predictors for TIA mimics ( < 0.001) whereas facial palsy ( < 0.001) motor weakness ( < 0.001), dysarthria ( = 0.022) and sensory impairment ( < 0.001) were independent predictors of TIA. TIA mimics in elderly patients are more likely to be internal medicine diseases and epilepsy compared to younger patients. Excluding internal medicine diseases seems to be important in elderly patients. Facial palsy, motor weakness, dysarthria and sensory impairment are associated with TIA.
短暂性脑缺血发作（TIA）需要进一步的诊断评估以预防未来的缺血性卒中。然而，如果诊断错误，预防性治疗对老年人可能有害。我们旨在描述年轻和老年患者中TIA模拟疾病的差异，以提高老年患者的诊断准确性。在一家三级医疗大学医院的专门神经急诊室（nER），对有短暂性神经症状且怀疑为TIA（<24小时）的患者的最终诊断和症状进行回顾性分析。使用描述性、单变量和多变量统计方法比较18 - 70岁和>70岁患者的这些参数。从2018年11月到2019年8月，共纳入386例连续患者。271例（70%）有心血管危险因素，所有患者均接受了脑部成像检查，大多为CT[376例（97%）]。各年龄组间确诊TIA的比例无差异[85例（46%）对58例（39%）；P = 0.213]。老年患者中的TIA模拟疾病更常为内科疾病[35例（19%）对7例（5%）；P < 0.001]和癫痫发作[48例（26%）对24例（16%）；P = 0.032]，但偏头痛较少见[2例（1%）对20例（13%）；P < 0.001]。所有患者中最常见的症状是失语和构音障碍[107例（28%）和92例（24%）]。老年患者感觉障碍较少见[23例（11%）对54例（30%）；P < 0.001]。意识和定向障碍是TIA模拟疾病的独立预测因素（P < 0.001），而面瘫（P < 0.001）、运动无力（P < 0.001）、构音障碍（P = 0.022）和感觉障碍（P < 0.001）是TIA的独立预测因素。与年轻患者相比，老年患者中的TIA模拟疾病更可能是内科疾病和癫痫。排除内科疾病在老年患者中似乎很重要。面瘫、运动无力、构音障碍和感觉障碍与TIA有关。
