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Wat is het?
Transient focal neurological episodes (TFNEs)—often called "amyloid spells"—are brief, recurrent, and stereotyped episodes of neurological dysfunction closely
linked to Cerebral Amyloid Angiopathy (CAA).
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Clinical Features
- duration: usually last less than 30 minutes (frequently between 10 and 30 minutes)
- symptoms: involve sensory, motor, visual, or language disturbances. They can be positive (such as tingling/paresthesia or visual sparks) or negative (such as numbness, weakness, or difficulty speaking/dysphasia), often featuring a characteristic slow, somatotopic "migrating" or spreading pattern across the body or face
- recurrence: they frequently happen in clusters over days or weeks and look very similar each time
Underlying Cause
- unlike a traditional stroke, TFNEs are typically not caused by a blocked artery
- instead, they are triggered by tiny, localized surface bleedings in the brain—specifically convexity subarachnoid hemorrhage (cSAH) or cortical superficial siderosis (cSS)—which irritate the outer brain tissue and cause a wave of electrical disruption known as cortical spreading depolarization
Why Accurate Diagnosis is Crucial
- dangerous mimics: TFNEs are frequently misdiagnosed as Transient Ischemic Attacks (TIA's), focal seizures, or migraine auras
- high risk of major bleed: having TFNEs is a major warning sign. It indicates a high future risk of a severe lobar intracerebral hemorrhage (brain stroke/bleed)
- avoid antithrombotics: because doctors often mistake TFNEs for TIAs, patients are dangerously prescribed antiplatelet or anticoagulant drugs (blood thinners), which significantly increase the risk of catastrophic brain bleeding in CAA patients. Blood-sensitive MRI-scan are vital to properly identify CAA and bleeding residues
Bronnen:
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