Scutelnic Adrian, Auf der Maur Seraina Michèle, Branca Mattia, Beyeler Morin, Horvath Thomas, Bücke Philip, Meinel Thomas, Lebedeva Elena R, Olesen Jes, Riederer Franz, Dobrocky Tomas, Gralla Jan, Arnold Marcel, Fischer Urs, Mattle Heinrich P, Jung Simon, Schankin Christoph J
Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
CTU Bern, University of Bern, Bern, Switzerland.
J Neurol. 2024 Dec 16;272(1):79. doi: 10.1007/s00415-024-12733-2.
Explicit diagnostic criteria for transient ischemic attack (TIA) (EDCT) have been recently proposed based on the assumption, that a migraine aura-like symptom is not typical for a TIA. However, migraine-like symptoms have been unexpectedly frequent in patients with confirmed ischemic stroke. This cross-sectional study aimed to field-test the EDCT to distinguish transient neurological symptoms caused by cerebral infarction from those caused by migraine aura.
The sensitivity, specificity, positive and negative predictive values of the EDCT score were calculated in samples of patients with (i) transient symptoms caused by cerebral infarction confirmed by imaging and (ii) patients with migraine with aura diagnosed according to the International Classification of Headache Disorders 3rd edition. Sensitivity, specificity, positive and negative predictive values of the original and modified EDCT were calculated, as well as area under the curve adjusted for age and sex using the logistic regression method.
The study population included 59 patients with cerebral infarction and 324 patients with migraine with aura. The median age of the stroke group was 72 (IQR 61-81) and of the migraine group 39 (IQR 29-53). There were 36 (61%) men in the stroke group and 221 (68%) women in the migraine group. For the detection of TIA with imaging-proven cerebral infarction, the original EDCT had a sensitivity of 90% (95%CI 79-96), a specificity 77% (95%CI 72-82), a positive predictive value of 42% (95%CI 33-51), and the negative predictive value 98% (95% CI 95-99). For the modified EDCT, the sensitivity was 81% (95%CI 69-90), the specificity 97% (95%CI 94-98), the positive predictive value 81% (95%CI 69-90), and the negative predictive value 97% (95%CI 94-98).
The original and modified EDCT criteria miss up to 1 of 10 and 1 of 5 patients, respectively, with transient symptoms due to cerebral infarction. However, the modified EDCT criteria are more specific but less sensitive in detection of ischemic events. The optimal combination of clinical markers to reliably distinguish TIA from migraine aura remains to be found.
基于偏头痛样症状并非短暂性脑缺血发作（TIA）典型症状这一假设，近期提出了TIA的明确诊断标准（EDCT）。然而，在确诊的缺血性卒中患者中，偏头痛样症状却出人意料地常见。这项横断面研究旨在对EDCT进行实地测试，以区分由脑梗死引起的短暂性神经症状和由偏头痛先兆引起的症状。
在以下两组患者样本中计算EDCT评分的敏感性、特异性、阳性预测值和阴性预测值：（i）经影像学证实由脑梗死引起短暂性症状的患者；（ii）根据《国际头痛疾病分类》第3版诊断为伴有先兆偏头痛的患者。计算原始和改良EDCT的敏感性、特异性、阳性预测值和阴性预测值，以及使用逻辑回归方法调整年龄和性别后的曲线下面积。
研究人群包括59例脑梗死患者和324例伴有先兆偏头痛的患者。卒中组的中位年龄为72岁（四分位间距61 - 81岁），偏头痛组为39岁（四分位间距29 - 53岁）。卒中组有36名男性（61%），偏头痛组有221名女性（68%）。对于检测经影像学证实为脑梗死的TIA，原始EDCT的敏感性为90%（95%置信区间79 - 96），特异性为77%（95%置信区间72 - 82），阳性预测值为42%（95%置信区间33 - 51），阴性预测值为98%（95%置信区间95 - 99）。对于改良EDCT，敏感性为81%（95%置信区间69 - 90），特异性为97%（95%置信区间94 - 98），阳性预测值为81%（95%置信区间69 - 90），阴性预测值为97%（95%置信区间94 - 98）。
原始和改良的EDCT标准分别遗漏了高达十分之一和五分之一因脑梗死出现短暂性症状的患者。然而，改良的EDCT标准在检测缺血性事件时更具特异性，但敏感性较低。可靠区分TIA和偏头痛先兆的临床标志物的最佳组合仍有待发现。
