title: Is the long-term prognosis of transient ischemic attack or minor ischemic stroke affected by the occurrence of nonfocal symptoms?
abstract: OBJECTIVE
  In patients with a transient ischemic attack or ischemic stroke, nonfocal neurological symptoms, such as confusion and nonrotatory dizziness, may be associated with a higher risk of vascular events. We assessed the relationship between nonfocal symptoms and the long-term risk of vascular events or death in patients with a transient ischemic attack or minor ischemic stroke.
  
  
  METHODS
  We related initial symptoms with outcome events in 2409 patients with a transient ischemic attack (n=723) or minor ischemic stroke (n=1686), included in the Life Long After Cerebral ischemia cohort. All patients underwent a standardized interview on the occurrence of focal and nonfocal neurological symptoms during the qualifying event. The primary outcome was the composite of any stroke, myocardial infarction, or vascular death. Secondary outcomes were all-cause death, vascular death, cardiac death, myocardial infarction, and stroke. Hazard ratios were calculated with Cox regression.
  
  
  RESULTS
  Focal symptoms were accompanied by nonfocal symptoms in 739 (31%) patients. During a mean follow-up of 10.1 years, the primary outcome occurred in 1313 (55%) patients. There was no difference in the risk of the primary outcome between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (adjusted hazard ratio, 0.97; 95% confidence interval, 0.86-1.09; P=0.60). The risk of each of the secondary outcomes was also similar in both groups.
  
  
  CONCLUSIONS
  About one third of the patients with a transient ischemic attack or minor ischemic stroke has both focal and nonfocal neurological symptoms. Nonfocal symptoms are not associated with an increased long-term risk of vascular events or death.
  
  
  BACKGROUND
  This trial was not registered because enrollment began before July 1, 2005.
authors.affiliation: From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (A.C., H.B.v.d.W., J.v.G., L.J.K., A.A.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (P.J.K.); and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.).
authors.forename: Annette
authors.initials: A
authors.lastname: Compter
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
authors.forename: Jan
authors.initials: J
authors.lastname: van Gijn
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D013997:Time Factors
keywords: ischemic attack, transient; stroke