IDIOPATHIC INTRACRANIAL HYPERTENSION | 10.01.2023

TRANSITIONAL NEUROLOGICAL DISORDERS

Transient neurological disorders are symptoms that cause short-term loss of strength, sensation, vision or balance, and impaired speech or consciousness. They can be observed due to many reasons. It is important to detect and diagnose the underlying cause, and thus they should be carefully investigated.

Transient Ischemic Attack (TIA)

Transitional Neurological Disorders: Transient Ischemic Attack (TIA) - Migraine with Aura - Focal Epileptic Seizures - Structural Lesions - Metabolic Disorders - Syncope and Pre-syncope

Fotoğraf: Dilek Necioğlu Örken

These are characterised as short-term focal neurologic symptoms that occur with temporary interruption of brain, spinal cord, or retinal blood flow, and a concurrent brain diffusion MRI should be normal. TIA does not kill brain cells like stroke and does not cause disability. However, it can be a warning sign of an impending stroke, and the symptoms are the same as for a stroke. It should never be neglected because 10% of strokes exhibit TIA before. The first year after a TIA is critical because a person who has a TIA has a 10-fold increased risk of stroke. 5% of patients have a stroke within the first month, 12% within the first year, 20% within the first 2 years, and 25% within the first 3 years. When a patient who has had a TIA applies to the doctor, the examination is completely routine. However, the patient should be examined as if he had a stroke, and the underlying cause should be found and appropriate treatment should be started.

Migraine with Aura

The neurological symptoms that precede the headache are called aura. The incidence of migraine with aura is 5.3% in women and 1.9% in men. 81% of patients with migraine with aura also experience migraine attacks without aura. Auras seen in a migraine attack can be in the form of visual, sensory or speech disorders and weakness. It usually lasts 5-60 minutes. Although the aura usually comes before the headache, it can also be seen during the pain and, rarely, after the pain.

Sometimes aura can be observed without the headache. In such cases, other underlying diseases should be investigated and eliminated.

Transient Focal Neurological Episodes Due to Cerebral Amyloid Angiopathy

Cerebral amyloid angiopathy (CAA) is a disease of the small vessels that primarily affects the cerebral cortex and membrane. Amyloid beta deposition causes damage to the vessel wall. Thickening, hyalinization and loss of smooth muscle cells occur in the vessel wall. As a result, they cause both ischemia and haemorrhage and damage the brain tissue. CAA can cause lobar haemorrhages in the brain, cortical subarachnoid haemorrhages and temporary neurological pictures (amyloid spells). These transient manifestations are often repetitive and identical symptoms (usually sensory and motor) that usually last less than 30 minutes. Focal findings spread (such as from hand to forearm, and face). Transient focal neurological episodes due to CAA may herald intracerebral haemorrhage (ICH). ICH develops in 50% of these people within the first fourteen months. Just like in TIA, the neurological examination improves when the patient comes to the physician. Patients should be investigated to exclude other diagnoses as appropriate. MR sequences sensitive to bleeding play an important role in the diagnosis of CAA.

Focal Epileptic Seizures

Epileptic seizure is a temporary event that occurs as a result of temporary abnormal electricity spread in the nerve cells in the cerebral cortex and affects the emotions, perception and movements of the person. Focal -that is, limited to one part of the brain- seizures either remain limited in that region or become generalized by spreading to other parts of the brain. Generalized seizures commonly begin in the brain. Seizure symptoms vary depending on which area of the brain is affected. Recurrent seizures can cause temporary paralysis or other neurological deficit, called Todd's paresis, after the seizure ends. Such deficits last for minutes or hours, or, rarely, even longer.

Structural Lesions

Tumors, vascular malformations, and subdural hematomas can surprisingly cause transient neurological deficits. Differential diagnosis should be conducted through imaging techniques.

Metabolic Disorders

Metabolic disorders, especially low or very high blood sugar, can cause focal neurological signs such as paralysis on the one hand. For this reason, blood sugar should be checked in case of temporary neurological deficit.

Syncope and Pre-syncope

Syncope is the sudden and temporary loss of consciousness due to impaired cerebral blood flow. Loss of consciousness is usually less than 1 minute and is accompanied by facial pallor, sweating and cold skin. The eyes are open or turned up, and there may sometimes be stiffness and thrashing of the arms and legs. Recovery is rapid and confusion clears within seconds after fainting.

Transient Global Amnesia

It is a disease that occurs in middle and old age and lasts less than 24 hours. It is a severe form of forgetfulness that mainly goes forward (anterograde) but also backward (retrograde). During the attack, the patient is unaware of his amnesia and repeatedly asks questions about his/her condition, identity and whereabouts.

SOURCE:
Smith E.E, Charidimou A, Ayata C, Werring D.J.
Cerebral amyloid angiopathy related transient focal neurologic episodes. Neurology 2021
Caplan L.R
Differential diagnosis of transient ischemic attack and acute stroke. Up to Date 2021

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