Bots M L, van der Wilk E C, Koudstaal P J, Hofman A, Grobbee D E
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Stroke. 1997 Apr;28(4):768-73. doi: 10.1161/01.str.28.4.768.
Patients with typical transient ischemic attacks (TIAs) have a higher risk of stroke but a lower risk of cardiac events than patients with nonspecific transient neurological symptoms. We assessed the prevalences of typical TIAs and nonspecific transient neurological attacks (TNAs) and their determinants in the general population because such data are virtually absent.
The Rotterdam Study is a population-based cohort study of 7983 subjects, aged 55 years and over, conducted in a district of Rotterdam, the Netherlands. At baseline examination, a history of episodes of disturbances in sensibility, strength, speech, and vision that lasted less than 24 hours and occurred within the preceding 3 years was determined by a trained physician. When such a history was present, information on time of onset, duration, and disappearance of symptoms and a detailed description of the symptoms (in ordinary language) were obtained. Subjects were classified by a neurologist as typical TIA or nonspecific TNA.
Prevalence of TNAs was 1.9% in subjects aged 55 to 64 years, 3.5% in subjects aged 65 to 74 years, 4.3% in subjects aged 75 to 84 years, and 5.1% in subjects aged 85 years or over. Prevalence figures for typical TIA were 0.9%, 1.7%, 2.3%, and 2.2% and for nonspecific TNA 1.0%, 1.8%, 2.0%, and 2.9%, respectively. Clinical parameters such as number of attacks, onset, duration, and disappearance of symptoms were similar for typical TIA and nonspecific TNA. Increased age, male sex, diabetes mellitus, low HDL cholesterol, Q-wave myocardial infarction on electrocardiogram, and carotid atherosclerosis were related to typical TIA, whereas increased age, hypertension, low HDL cholesterol, smoking, and angina pectoris were associated with nonspecific TNA.
About half of the subjects with a TNA had symptoms that were not entirely typical for a TIA. Differences in associations with risk factors between typical TIA and nonspecific TNA point toward different underlying mechanisms of symptoms and may lead to different ancillary investigations and possibly treatment.
与具有非特异性短暂性神经症状的患者相比，典型短暂性脑缺血发作（TIA）患者发生卒中的风险更高，但发生心脏事件的风险更低。由于几乎没有此类数据，我们评估了普通人群中典型TIA和非特异性短暂性神经发作（TNA）的患病率及其决定因素。
鹿特丹研究是一项基于人群的队列研究，在荷兰鹿特丹的一个地区对7983名年龄在55岁及以上的受试者进行。在基线检查时，由一名经过培训的医生确定在过去3年内发生的持续时间少于24小时的感觉、力量、言语和视力障碍发作史。当存在此类病史时，获取症状发作时间、持续时间和消失时间的信息以及症状的详细描述（用普通语言）。由一名神经科医生将受试者分类为典型TIA或非特异性TNA。
55至64岁受试者中TNA的患病率为1.9%，65至74岁受试者中为3.5%，75至84岁受试者中为4.3%，85岁及以上受试者中为5.1%。典型TIA的患病率分别为0.9%、1.7%、2.3%和2.2%，非特异性TNA的患病率分别为1.0%、1.8%、2.0%和2.9%。典型TIA和非特异性TNA的临床参数，如发作次数、发作、持续时间和症状消失情况相似。年龄增加、男性、糖尿病、高密度脂蛋白胆固醇降低、心电图显示Q波心肌梗死和颈动脉粥样硬化与典型TIA相关，而年龄增加、高血压、高密度脂蛋白胆固醇降低、吸烟和心绞痛与非特异性TNA相关。
约一半TNA受试者的症状并非完全典型的TIA症状。典型TIA和非特异性TNA与危险因素的关联差异表明症状的潜在机制不同，可能导致不同的辅助检查以及可能的治疗方法。
