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Abstract
Background: 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.Methods: 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.Results: 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%); p = 0.213].TIA mimics in the elderly were more often internal medicine diseases [35 (19%) vs. 7 (5%); p < 0.001] and epileptic seizures [48 (26%) vs. 24 (16%); p = 0.032] but less often migraine [2 (1%) vs. 20 (13%); p < 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%); p < 0.001]. Impaired consciousness and orientation were independent predictors for TIA mimics (p < 0.001) whereas facial palsy (p < 0.001) motor weakness (p < 0.001), dysarthria (p = 0.022) and sensory impairment (p < 0.001) were independent predictors of TIA.Conclusion: 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.
Highlights
Up to 70% of transient neurological symptoms without acute cerebral infarction have underlying causes that mimic the signs but are distinct to transient ischemic attacks (TIA) and are called TIA mimics [1,2,3]
In order to analyze an age-dependent distribution of TIA mimics in comparison to diagnosed TIAs, we conducted a cross-sectional study of consecutive patients who presented to our neurological emergency room with transient neurological symptoms suggestive of a TIA
We aimed at answering three questions: [1] Does the etiology differ in TIA mimics of older and younger patients? [2] Which symptoms are most frequent in elderly patients with transient neurological symptoms? [3] Which symptoms can predict TIA mimics in elderly patients?
Summary
Up to 70% of transient neurological symptoms without acute cerebral infarction have underlying causes that mimic the signs but are distinct to transient ischemic attacks (TIA) and are called TIA mimics [1,2,3]. In elderly patients, a primary prevention with aspirin (due to misdiagnosis) has been shown to be associated with an increased risk for gastrointestinal bleeding and did not result in a considerable risk reduction of cardiovascular events or extension in overall survival [4,5,6,7]. This becomes even more important in western countries due to the increasing percentage of aged people in the population [8]. We aimed at characterizing differences in TIA mimics in younger and older patients to enhance diagnostic accuracy in elderly patients
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