Transient ischemic attack (TIA) can occur without self-awareness of symptoms. We aimed to investigate characteristics of patients with tissue-based diagnosis of TIA but having no self-awareness of their symptoms and whose symptoms were witnessed by bystanders.
We used data from the multicenter registry of 1,414 patients with clinical diagnosis of TIA. For patients without evidence of ischemic lesions on imaging, clinical characteristics were compared between patients with and without self-awareness of their TIA symptoms.
Among 896 patients (559 men, median age of 70 years), 59 (6.6%) were unaware of their TIA symptoms, but had those symptoms witnessed by bystanders. Patients without self-awareness of symptoms were older and more frequently female, and more likely to have previous history of stroke, premorbid disability, and atrial fibrillation, but less likely to have dyslipidemia than those with self-awareness. Patients without self-awareness of symptoms arrive hospitals earlier than those with self-awareness (P <0.001). ABCD score was higher in patients without self-awareness of symptoms than those with self-awareness (median 5 vs. 4, P=0.002). Having no self-awareness of symptoms was a significant predictor of ischemic stroke within 1 year after adjustment for sex and ABCD score (hazard ratio 2.71, 95% confidential interval 1.24-5.31), but was not significant after further adjustment for arterial stenosis or occlusion.
Patients with TIA but having no self-awareness of their symptoms might have higher risk of subsequent ischemic stroke rather than those with self-awareness, suggesting urgent management is needed even if patients have no self-awareness of symptoms.

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