Spectrum of Transient Visual Symptoms in a Transient Ischemic Attack Cohort

被引:32
作者
Lavallee, Philippa C. [1 ,2 ,3 ,4 ]
Cabrejo, Lucie [1 ,2 ,3 ,4 ]
Labreuche, Julien [1 ,2 ]
Mazighi, Mikael [1 ,2 ,3 ,4 ]
Meseguer, Elena [1 ,2 ,3 ,4 ]
Guidoux, Celine [1 ,2 ,3 ,4 ]
Abboud, Halim [3 ,4 ]
Lapergue, Bertrand [3 ,4 ]
Klein, Isabelle F. [1 ,2 ,5 ]
Olivot, Jean-Marc [3 ,4 ]
Sirimarco, Gaia [1 ,2 ,3 ,4 ]
Gonzales-Valcarcel, Jaime [1 ,2 ,3 ,4 ]
Touboul, Pierre-Jean [1 ,2 ,3 ,4 ]
Amarenco, Pierre [1 ,2 ,3 ,4 ]
机构
[1] INSERM, U698, Paris, France
[2] Paris Diderot Univ, Sorbonne Paris Cite, Paris, France
[3] Hop Xavier Bichat, Dept Neurol, F-75018 Paris, France
[4] Hop Xavier Bichat, Stroke Ctr, F-75018 Paris, France
[5] Hop Xavier Bichat, Dept Radiol, F-75018 Paris, France
关键词
amaurosis fugax; ischemic attack; transient; PAROXYSMAL ATRIAL-FIBRILLATION; MONOCULAR BLINDNESS; CAROTID-ARTERY; STROKE; PROGNOSIS; DIAGNOSIS; PATTERNS; LESIONS; TIA;
D O I
10.1161/STROKEAHA.113.002420
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose Transient visual symptoms (TVS) are common complaints. They can be related to transient ischemic attacks, but the nature of the symptoms often remains uncertain, and data on prognosis are scarce. We studied the prevalence, presentation, and effect of different types of TVS, paying particular attention to the association with high-risk pathology of embolism. Methods A total of 2398 patients with suspected transient ischemic attack admitted to the SOS-TIA clinic between January 2003 and December 2008 underwent immediate evaluation and treatment. Results Eight hundred twenty-six (34.5%) patients had TVS, including 422 (17.6%) patients with isolated TVS. Transient monocular blindness was the most frequent TVS (36.3%), followed by diplopia (13.4%), homonymous lateral hemianopia (12.3%), bilateral positive visual phenomena (10.8%), and lone bilateral blindness (4.5%). Positive diffusion-weighted imaging was found in 11.8%, 8.1%, 8.1%, and 5.0% of patients with homonymous lateral hemianopia, diplopia, lone bilateral blindness, and transient monocular blindness, respectively. Among 1850 patients (595 patients with TVS) with definite/possible transient ischemic attack or minor stroke, a major source of embolism of cardiac or arterial origin was found less frequently in patients with isolated or nonisolated TVS than in patients without TVS (19.6%; 19.7% versus 28.1%, respectively; P<0.001). However, we found a higher rate of atrial fibrillation in patients with homonymous lateral hemianopia (23.2%) than in patients with other TVS (4.0%; adjusted odds ratio, 6.71; 95% confidence interval, 2.99-15.06) or nonvisual symptoms (9.1%; adjusted odds ratio, 4.39; 95% confidence interval, 2.26-8.50). Conclusions Approximately 20% of patients with TVS had a major source of embolism detected, requiring urgent management. Atrial fibrillation was particularly frequent in patients with transient homonymous lateral hemianopia.
引用
收藏
页码:3312 / 3317
页数:6
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