Is the Long-Term Prognosis of Transient Ischemic Attack or Minor Ischemic Stroke Affected by the Occurrence of Nonfocal Symptoms?

Abstract

The present study is a post hoc analysis of the Life Long After Cerebral (LiLAC) ischemia study, which in turn was based on the DTT. The design and results of both studies have been published. 6,7 Background and Purpose-In patients with a transient ischemic attack or ischemic stroke, nonfocal neurological symptoms, such as confusion and nonrotatory dizziness, may be associated with a higher risk of vascular events. We assessed the relationship between nonfocal symptoms and the long-term risk of vascular events or death in patients with a transient ischemic attack or minor ischemic stroke. Methods-We related initial symptoms with outcome events in 2409 patients with a transient ischemic attack (n=723) or minor ischemic stroke (n=1686), included in the Life Long After Cerebral ischemia cohort. All patients underwent a standardized interview on the occurrence of focal and nonfocal neurological symptoms during the qualifying event. The primary outcome was the composite of any stroke, myocardial infarction, or vascular death. Secondary outcomes were all-cause death, vascular death, cardiac death, myocardial infarction, and stroke. Hazard ratios were calculated with Cox regression. Results-Focal symptoms were accompanied by nonfocal symptoms in 739 (31%) patients. During a mean follow-up of 10.1 years, the primary outcome occurred in 1313 (55%) patients. There was no difference in the risk of the primary outcome between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (adjusted hazard ratio, 0.97; 95% confidence interval, 0.86-1.09; P=0.60). The risk of each of the secondary outcomes was also similar in both groups. Conclusions-About

Nonfocal Symptoms in Patients with Transient Ischemic Attack or Ischemic Stroke: Occurrence, Clinical Determinants, and Association with Cardiac History

“…The higher prevalence of use of oral contraceptives in patients with paresthesia was not reported before. In contrast to previous studies, patients with nonfocal symptoms more frequently had other well-known cardiovascular risk factors [2,4,7] . Significant carotid stenosis was less frequently found in patients with accompanying nonfocal symptoms.…”

“…Furthermore, in the Rotterdam study, patients were asked to reveal the nonfocal symptoms that they had observed in the last 3 years; conversely in our study, a systematic registration of accompanying nonfocal symptoms was provided shortly after the TIA or minor ischemic stroke. The higher prevalence of nonfocal symptoms in 2 other studies might be due to differently registered nonfocal symptoms and a higher frequency of posterior stroke in these studies [2,3] . In this study, cardiac history was not more frequently observed in patients with accompanying nonfocal symptoms.…”

“…In a study in the general population, patients with a TIA accompanied by nonfocal symptoms are in particular at high risk of cardiac events [1,6] . However, in a recent hospital-based study, nonfocal symptoms were not associated with an increased long-term risk of vascular events or death [2] . The etiology of nonfocal symptoms in patients with TIA or ischemic stroke is still unclear and very likely heterogeneous [6][7][8] .…”

“…Another study found brady arrhythmias in a subgroup of patients aged under 30 [8] . On the other hand, another large study showed no association between nonfocal symptoms and an increased long-term risk of (cardio)vascular events [2] .…”

“…Previous studies in patients with TIA found a relative frequency of nonfocal symptoms varying from 18 to 53% [1][2][3] . A large populationbased study has shown accompanying nonfocal symptoms in 12% of patients with TIA [4] .…”