Nonfocal Transient Neurological Attacks Are Associated With Cerebral Small Vessel Disease

Eline A. Oudeman*, Jacoba P. Greving, Renske M. Van den Berg-Vos, Geert Jan Biessels, Esther E. Bron, Robert van Oostenbrugge, Jeroen de Bresser, L. Jaap Kappelle, Heart-Brain Connection Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background and Purpose-Nonfocal transient neurological attacks (TNAs), such as unsteadiness, bilateral weakness, or confusion, are associated with an increased risk of stroke and dementia. Cerebral ischemia plays a role in their pathogenesis, but the precise mechanisms are unknown. We hypothesized that cerebral small vessel disease is involved in the pathogenesis of TNAs and assessed the relation between TNAs and manifestations of cerebral small vessel disease on magnetic resonance imaging.

Methods-We included participants from the HBC (Heart-Brain Connection) study. In this study, hemodynamic and cardiovascular contributions to cognitive impairment have been studied in patients with heart failure, carotid artery occlusion, or possible vascular cognitive impairment, as well as in a reference group. We excluded participants with a history of stroke or transient ischemic attacks. The occurrence of the following 8 TNAs was assessed with a standardized interview: unconsciousness, confusion, amnesia, unsteadiness, bilateral leg weakness, blurred vision, nonrotatory dizziness, and paresthesias. The occurrence of TNAs was related to the presence of lacunes or white matter hyperintensities (Fazekas score, >= 2; early confluent or confluent lesions) in logistic regression analysis, adjusted for age, sex, and hypertension.

Results-Of 304 participants (60% men; mean age, 679 years), 63 participants (21%) experienced >= 1 TNAs. Lacunes and early confluent or confluent white matter hyperintensities were more common in participants with TNAs than in participants without TNAs (35% versus 20%; adjusted odds ratio, 2.32 [95% CI, 1.22-4.40] and 48% versus 27%; adjusted odds ratio, 2.65 [95% CI, 1.44-4.90], respectively).

Conclusions-In our study, TNAs are associated with the presence of lacunes and early confluent or confluent white matter hyperintensities of presumed vascular origin, which indicates that cerebral small vessel disease might play a role in the pathogenesis of TNAs.

Original languageEnglish
Pages (from-to)3540-3544
Number of pages5
Issue number12
Publication statusPublished - Dec 2019


  • cerebral small vessel diseases
  • humans
  • magnetic resonance imaging
  • neurologic manifestations
  • odds ratio
  • RISK


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