Transient neurologic syndromes: A diagnostic approach

Article Figures & Data

TABLE 1

Transient ischemic attack, migraine aura, and partial seizure

	Transient ischemic attack	Migraine aura	Partial seizure
Demographics	Age > 55 Vascular risk factors Atrial fibrillation	Age 25–55 History of headache May occur de novo in the elderly	Any age History of trauma, central nervous system infection, or stroke
Onset and duration	Abrupt onset Resolves in < 10 minutes	Gradual, crescendo onset (5–10 minutes) Resolves within 60 minutes	Abrupt onset with resolution in minutes
Progression	No Maximum deficits at onset	Yes Multiple modalities (visual, somatosensory)	Variable
Symptoms	Localized by vascular territory Negative symptoms (numbness, weakness, vision loss) Rarely associated with loss of consciousness or confusion	Positive symptoms (flashing lights or paresthesias) Precedes headache	Stereotypical pattern (head-turning, posturing, lip-smacking) Loss of consciousness Incontinence Tongue biting Postictal confusion Persistent paralysis (Todd paralysis)
Prognosis	Nearly 20% risk of stroke within 90 days	Chronic recurring course	Chronic without progression

TABLE 2

Hypoglycemic encephalopathy, hyperventilation syndrome, and transient global amnesia

	Hypoglycemic encephalopathy	Hyperventilation syndrome	Transient global amnesia
Duration	Minutes	Minutes	Hours (usually < 24 hours)
Triggers	Low blood sugar Long-standing diabetes	Anxiety	Recent stressor
Symptoms	Diffuse Sweating, anxiety, tremor, confusion, coma May cause focal weakness	Diffuse paresthesias, anxiety, fear of dying, unsteadiness, lightheadedness Reproducible	Amnesia for new events, repeated questioning, normal findings on neurologic examination
Recurrence	Usually	Usually	Uncommon

TABLE 3

Night terrors, somnambulism, and narcolepsy

	Night terrors	Somnambulism	Narcolepsy
Demographics	Children	Children	15–25 years old Male predominant
Triggers	Medication Anxiety Sleep deprivation	Medication Anxiety Sleep deprivation	Cataplexy triggered by strong emotions
Amnesia	Yes	Yes	No loss of consciousness or awareness during cataplexy attack
Distinguishing characteristic	Sympathetic activation	Complex motor behavior Family history Resolves	Excessive sleepiness Sleep paralysis with or without hypnagogic hallucination