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▎Transient ischemic attack (TIA), edited by WuXi AppTec's content team, is a transient neurological dysfunction caused by focal ischemia of the brain, spinal cord or retina without acute cerebral infarction, which is often referred to as " Minor stroke".
TIA is an important "signal" for subsequent strokes.
TIA will appear first in up to 25% of strokes.
Since many TIA patients may not be able to observe the manifestations of acute ischemia during imaging examinations, diagnosis based on symptoms is still common in clinical practice.
However, there is still a lack of consensus on "atypical" symptoms, related diagnosis is challenging, and a large number of patients may not receive standardized treatment.
The latest issue of The Lancet published an analysis from a research team at the University of Oxford, showing that TIA patients with atypical symptoms and TIA patients with typical symptoms have similar follow-up stroke risks and long-term risks.
This also suggests that some atypical symptoms that have not yet reached a diagnosis consensus are also worthy of attention, so as not to miss follow-up treatment and prevention.
Screenshot source: The Lancet This study analyzed the data of 92,728 patients in designated medical institutions in the Oxford Vascular Study (OXVASC).
During the period from April 1, 2002 to March 31, 2018, a total of 2878 cases of stroke or sudden transient neurological symptoms were identified, including 1287 cases of mild ischemic stroke and 1021 cases of TIA with typical symptoms 570 cases of atypical TIA.
These patients all received the corresponding secondary prevention treatment according to the guidelines.
The typical symptoms of TIA are defined as follows (all are sudden and transient): one or more body parts (face, arms, hands, legs) movement weakness dysphagia two or more body parts (face, arms, hands, legs) perception Loss of vision in part of the field of vision Loss of vision in one eye, vertigo, and other TIA symptoms, diplopia, and other TIA symptoms, dysphonia, slurred speech, and other TIA symptoms, ataxia, and other TIA symptoms.
TIA atypical symptoms are defined as follows (both are Sudden and transient): only dizziness (with or without nausea or vomiting), not caused by head movement or trauma, and no related earache, tinnitus or hearing loss; exclude non-specific dizziness (mostly persistent) or mild Headache cases.
Only ataxia, unsteady gait, and no other reasons, only diplopia, no obvious eye (such as retinal detachment) or neuromuscular causes, only dysphonia, slurred speech, only decreased vision in both eyes (including hemianopia or partial visual field) Loss), no other related symptoms, only a single body part (face, arms, hands, legs) unilateral sensory loss.
Image source: 123RF researchers followed them up to October 1, 2018 (median time 5.
2 years) for follow-up Their subsequent risk of stroke and all major vascular events.
A total of 577 follow-up stroke events occurred during the follow-up period.
The data shows that the risk of stroke 90 days after the occurrence of atypical TIA and typical TIA is similar (10.
6% vs 11.
6%), which is higher than the risk of stroke 90 days after transient amaurosis (a type of typical TIA) (4.
3%).
However, compared with patients with typical TIA, patients with atypical TIA have a significantly lower chance of seeing a doctor on the day of TIA-related symptoms (59% vs 75%), and are more likely to have a stroke before seeing a doctor.
The probability is 1.
77 times that of patients with TIA ( 8% vs 5%).
Moreover, even if strokes that occurred without prompt treatment are excluded, the risk of stroke (2.
9%) in patients with atypical TIA within 7 days after the consultation is much higher than that of ordinary people; for patients with atypical TIA who see a doctor on the same day, the risk of stroke is 7 days after consultation.
The risk of stroke (5.
9%) is 300 times that of ordinary people.
▲The 90-day stroke risk is similar for patients with typical TIA (red line) and atypical TIA (blue line).
(A) Starting from the TIA event (B) Starting from the medical treatment (C) Starting from the medical treatment, among the patients who saw the doctor on the day of the TIA event (D) Starting from the medical treatment, among the patients who did not start antiplatelet therapy at the beginning (Image source: Reference: Data [1]) A typical TIA patient is more likely to be prescribed drugs to prevent subsequent strokes within 1 month.
For example, 97% of patients with typical TIA are prescribed antithrombotic drugs, compared with 81% of patients with atypical TIA.
The gap in the prescription rate of antihypertensive drugs (77% vs 66%) and statins (80% vs 63%) is also similar.
The 10-year risk of all major vascular events in patients with atypical TIA and typical TIA was similar (27.
1% vs 30.
9%).
▲10-year risk of major vascular events in patients with typical TIA (red line) and atypical TIA (blue line) and mild stroke (green) (picture source: reference [1]) For patients with different atypical TIA symptoms, TIA 90 There is no significant difference between the risk of stroke after the first day and the 10-year risk of major cardiovascular events.
Based on these data, the research team pointed out that TIA patients with atypical symptoms also face a higher risk of short-term stroke and long-term cardiovascular events, similar to those with typical symptoms.
Moreover, taking into account patients with atypical symptoms, TIA diagnosis will increase by about 50%.
At the end of the paper, it is pointed out that the findings of this study have several effects on clinical practice: (1) It helps to improve the clinical diagnosis of TIA.
(2) For TIA patients with atypical symptoms, they should not be mistaken for a good prognosis, but should also be treated as TIA for clinical management.
(3) TIA patients with atypical symptoms should not be routinely excluded from clinical trials or other studies.
(4) Regardless of typical TIA or atypical TIA, a considerable number of patients have had a stroke before going to the doctor.
Patients need to be educated to seek medical treatment in time after sudden neurological symptoms.
(5) After the inclusion of atypical TIA, the increase in TIA diagnosis also puts forward requirements for imaging and other medical service capabilities.
Related reading JAMA: After a minor stroke, what is the probability of a stroke? The high-risk period is far more than 90 days! To prevent stroke, should the general population be screened for carotid artery stenosis? The latest US guidelines published 2 JAMA: Acute ischemic stroke, should thrombolysis before thrombus removal? Professor Yang Qingwu from the Army Military Medical University leads China's research on better prevention and treatment of heart disease and stroke.
AHA announced the top ten cardiovascular medical advances in 2020.
How much pain will stroke experience? After falling ill, the Oxford experts discovered that they "know little".
Source of the picture: 123RF Reference [1] Maria A Tuna, Peter M Rothwell, et al.
, (2021).
Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis.
The Lancet, DOI: https://doi.
org/10.
1016/S0140-6736(20)31961-9[2] China Transient Brain Guidelines for Early Diagnosis and Treatment of Ischemic Attack (2016) Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.
If you need guidance on treatment plans, please go to a regular hospital for treatment.
TIA is an important "signal" for subsequent strokes.
TIA will appear first in up to 25% of strokes.
Since many TIA patients may not be able to observe the manifestations of acute ischemia during imaging examinations, diagnosis based on symptoms is still common in clinical practice.
However, there is still a lack of consensus on "atypical" symptoms, related diagnosis is challenging, and a large number of patients may not receive standardized treatment.
The latest issue of The Lancet published an analysis from a research team at the University of Oxford, showing that TIA patients with atypical symptoms and TIA patients with typical symptoms have similar follow-up stroke risks and long-term risks.
This also suggests that some atypical symptoms that have not yet reached a diagnosis consensus are also worthy of attention, so as not to miss follow-up treatment and prevention.
Screenshot source: The Lancet This study analyzed the data of 92,728 patients in designated medical institutions in the Oxford Vascular Study (OXVASC).
During the period from April 1, 2002 to March 31, 2018, a total of 2878 cases of stroke or sudden transient neurological symptoms were identified, including 1287 cases of mild ischemic stroke and 1021 cases of TIA with typical symptoms 570 cases of atypical TIA.
These patients all received the corresponding secondary prevention treatment according to the guidelines.
The typical symptoms of TIA are defined as follows (all are sudden and transient): one or more body parts (face, arms, hands, legs) movement weakness dysphagia two or more body parts (face, arms, hands, legs) perception Loss of vision in part of the field of vision Loss of vision in one eye, vertigo, and other TIA symptoms, diplopia, and other TIA symptoms, dysphonia, slurred speech, and other TIA symptoms, ataxia, and other TIA symptoms.
TIA atypical symptoms are defined as follows (both are Sudden and transient): only dizziness (with or without nausea or vomiting), not caused by head movement or trauma, and no related earache, tinnitus or hearing loss; exclude non-specific dizziness (mostly persistent) or mild Headache cases.
Only ataxia, unsteady gait, and no other reasons, only diplopia, no obvious eye (such as retinal detachment) or neuromuscular causes, only dysphonia, slurred speech, only decreased vision in both eyes (including hemianopia or partial visual field) Loss), no other related symptoms, only a single body part (face, arms, hands, legs) unilateral sensory loss.
Image source: 123RF researchers followed them up to October 1, 2018 (median time 5.
2 years) for follow-up Their subsequent risk of stroke and all major vascular events.
A total of 577 follow-up stroke events occurred during the follow-up period.
The data shows that the risk of stroke 90 days after the occurrence of atypical TIA and typical TIA is similar (10.
6% vs 11.
6%), which is higher than the risk of stroke 90 days after transient amaurosis (a type of typical TIA) (4.
3%).
However, compared with patients with typical TIA, patients with atypical TIA have a significantly lower chance of seeing a doctor on the day of TIA-related symptoms (59% vs 75%), and are more likely to have a stroke before seeing a doctor.
The probability is 1.
77 times that of patients with TIA ( 8% vs 5%).
Moreover, even if strokes that occurred without prompt treatment are excluded, the risk of stroke (2.
9%) in patients with atypical TIA within 7 days after the consultation is much higher than that of ordinary people; for patients with atypical TIA who see a doctor on the same day, the risk of stroke is 7 days after consultation.
The risk of stroke (5.
9%) is 300 times that of ordinary people.
▲The 90-day stroke risk is similar for patients with typical TIA (red line) and atypical TIA (blue line).
(A) Starting from the TIA event (B) Starting from the medical treatment (C) Starting from the medical treatment, among the patients who saw the doctor on the day of the TIA event (D) Starting from the medical treatment, among the patients who did not start antiplatelet therapy at the beginning (Image source: Reference: Data [1]) A typical TIA patient is more likely to be prescribed drugs to prevent subsequent strokes within 1 month.
For example, 97% of patients with typical TIA are prescribed antithrombotic drugs, compared with 81% of patients with atypical TIA.
The gap in the prescription rate of antihypertensive drugs (77% vs 66%) and statins (80% vs 63%) is also similar.
The 10-year risk of all major vascular events in patients with atypical TIA and typical TIA was similar (27.
1% vs 30.
9%).
▲10-year risk of major vascular events in patients with typical TIA (red line) and atypical TIA (blue line) and mild stroke (green) (picture source: reference [1]) For patients with different atypical TIA symptoms, TIA 90 There is no significant difference between the risk of stroke after the first day and the 10-year risk of major cardiovascular events.
Based on these data, the research team pointed out that TIA patients with atypical symptoms also face a higher risk of short-term stroke and long-term cardiovascular events, similar to those with typical symptoms.
Moreover, taking into account patients with atypical symptoms, TIA diagnosis will increase by about 50%.
At the end of the paper, it is pointed out that the findings of this study have several effects on clinical practice: (1) It helps to improve the clinical diagnosis of TIA.
(2) For TIA patients with atypical symptoms, they should not be mistaken for a good prognosis, but should also be treated as TIA for clinical management.
(3) TIA patients with atypical symptoms should not be routinely excluded from clinical trials or other studies.
(4) Regardless of typical TIA or atypical TIA, a considerable number of patients have had a stroke before going to the doctor.
Patients need to be educated to seek medical treatment in time after sudden neurological symptoms.
(5) After the inclusion of atypical TIA, the increase in TIA diagnosis also puts forward requirements for imaging and other medical service capabilities.
Related reading JAMA: After a minor stroke, what is the probability of a stroke? The high-risk period is far more than 90 days! To prevent stroke, should the general population be screened for carotid artery stenosis? The latest US guidelines published 2 JAMA: Acute ischemic stroke, should thrombolysis before thrombus removal? Professor Yang Qingwu from the Army Military Medical University leads China's research on better prevention and treatment of heart disease and stroke.
AHA announced the top ten cardiovascular medical advances in 2020.
How much pain will stroke experience? After falling ill, the Oxford experts discovered that they "know little".
Source of the picture: 123RF Reference [1] Maria A Tuna, Peter M Rothwell, et al.
, (2021).
Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis.
The Lancet, DOI: https://doi.
org/10.
1016/S0140-6736(20)31961-9[2] China Transient Brain Guidelines for Early Diagnosis and Treatment of Ischemic Attack (2016) Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.
If you need guidance on treatment plans, please go to a regular hospital for treatment.
