Usefulness of EEG for the differential diagnosis of possible transient ischemic attack

脑电图对短暂性脑缺血发作的鉴别诊断的有效性

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作者:Carla Bentes, Patrícia Canhão, Ana Rita Peralta, Pedro Viana, Ana Catarina Fonseca, Ruth Geraldes, Teresa Pinho E Melo, Teresa Paiva, José Manuel Ferro

Conclusions

FSWA was the commonest EEG abnormality found in the early EEG of patients with possible TIA, but did not distinguish between TIA and seizure patients. In patients with seizures, FSWA was more common than EA and its presence in the late EEG was more likely in patients with epileptic seizures than with TIA. Significance: The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG.

Methods

Prospective longitudinal study of possible TIA patients evaluated at a tertiary centre during 36 months and with 1-3 months follow-up. EEG was performed as soon as possible (early EEG) and one month later (late EEG). A stroke neurologist established final diagnosis after reassessing all clinical and diagnostic tests.

Objective

EEG value in possible transient ischemic attacks (TIA) is unknown. We aim to quantify focal slow wave activity (FSWA) and epileptiform activity (EA) frequency in possible TIA, and to analyse its contribution to the final diagnosis of seizures and/or definitive TIA.

Results

80 patients underwent an early EEG (45.8 h after possible TIA): 52 had FSWA and 6 of them also EA. Early FSWA was associated with epileptic seizure or definitive TIA final diagnosis (p = .041). Patients with these diagnoses had more frequently early FSWA (19/23; 82.6%) than EA (6/23; 26.1%). 6/13 (46.2%) patients with epileptic seizure final diagnosis had EA.In the late EEG, 43 (58.1%) patients demonstrated persistent FSWA and 3 of them also EA. Persistent FSWA in the late EEG was more frequent in seizures than in TIA patients (91.7% vs. 45.5%). FSWA disappearance was associated with acute vascular lesion on neuroimage. Conclusions: FSWA was the commonest EEG abnormality found in the early EEG of patients with possible TIA, but did not distinguish between TIA and seizure patients. In patients with seizures, FSWA was more common than EA and its presence in the late EEG was more likely in patients with epileptic seizures than with TIA. Significance: The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG.

Significance

The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG.

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