Meningeal disease masquerading as transient ischemic attack

Abstract

Background: Cortical subarachnoid hemorrhage and meningitis sometimes present as episodes of transient neurologic dysfunction mimicking transient ischemic attack (TIA). In the present study, we sought to determine the frequency of meningeal disease among patients treated in a TIA clinic.

Methods: Data from patients consecutively admitted to a TIA clinic were retrospectively analyzed. Patients were classified as ischemic events (TIA or minor stroke) or nonischemic events using clinical data and findings from brain imaging and ultrasound studies.

Results: Of 529 patients (mean age 63.5 years), 134 (25.3%) were classified as nonischemic events. Meningeal disease was the likely cause of clinical symptoms in 9 patients (1.7%; 95% confidence interval, .6%-2.8%) including 5 patients with meningitis (1 meningeal sarcoidosis, 1 rheumatoid meningitis, 1 myelomatous meningitis, 1 lymphomatous meningitis, and 1 herpes simplex virus 1 meningoencephalitis) and 4 patients with cortical subarachnoid hemorrhage (probably or possibly related to cerebral amyloid angiopathy in 3 patients). Clinical symptoms comprised motor deficit, sensory deficit, aphasia, and dysarthria. Transient neurologic dysfunction was recurrent in 7 of 9 patients. Duration of transient episodes ranged from 5-30 minutes. No patient suffered headache. No patient had nuchal rigidity. Magnetic resonance imaging (MRI) showed evidence of meningeal or meningocerebral disease in all 9 patients.

Conclusions: Our study confirmed that serious meningeal disease could present as TIA, but this disease was relatively uncommon among patients treated in a TIA clinic. The findings highlight the diagnostic value of MRI in patients with suspected TIA.

Keywords: MRI; Transient ischemic attack; cerebral amyloid angiopathy; cortical subarachnoid hemorrhage; meningeal or meningocerebral disease; meningitis.