Transient ischemic attack: Difference between revisions
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== Background == | == Background == | ||
*Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction | *Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction | ||
*Should be viewed as analogous to unstable angina | *Should be viewed as analogous to unstable angina | ||
===Prognosis=== | |||
*ABCD2 Score | |||
**Risk of stroke at 2d, 7d, and 90d from TIA | |||
**Although prognostic, evidence-based admission thresholds have not been determined | |||
*Score | |||
**Age >60yr (1 pt) | |||
**BP (SBP >140 OR diastolic >90) (1 pt) | |||
**Clinical Features | |||
***Isolated speech disturbance (1 pt) | |||
***Unilateral weakness (2 pts) | |||
**Duration of symptoms | |||
***10-59 min (1 pt) | |||
***>60 min (2 pts) | |||
**DM (1 pt) | |||
{| style="width: 500px" border="1" cellpadding="1" cellspacing="1" | |||
|- | |||
| '''Points<br>''' | |||
| '''Stroke Risk<br>''' | |||
| '''Two Days<br>''' | |||
| '''Seven Days <br>''' | |||
| '''90 Days<br>''' | |||
|- | |||
| 0-3<br> | |||
| Low<br> | |||
| 1.0%<br> | |||
| 1.2%<br> | |||
| 3.1%<br> | |||
|- | |||
| 4-5<br> | |||
| Moderate<br> | |||
| 4.1%<br> | |||
| 5.9%<br> | |||
| 9.8%<br> | |||
|- | |||
| 6-7<br> | |||
| High<br> | |||
| 8.1%<br> | |||
| 11.7%<br> | |||
| 17.8%<br> | |||
|} | |||
None with score <3 had CVA within one week in study | |||
== Background == | == Background == | ||
| Line 46: | Line 89: | ||
== Disposition == | == Disposition == | ||
===Admission Criteria=== | ===Admission Criteria=== | ||
==== AHA/ASA Guidelines ==== | ==== AHA/ASA Guidelines ==== | ||
Revision as of 04:29, 29 September 2011
Background
- Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction
- Should be viewed as analogous to unstable angina
Prognosis
- ABCD2 Score
- Risk of stroke at 2d, 7d, and 90d from TIA
- Although prognostic, evidence-based admission thresholds have not been determined
- Score
- Age >60yr (1 pt)
- BP (SBP >140 OR diastolic >90) (1 pt)
- Clinical Features
- Isolated speech disturbance (1 pt)
- Unilateral weakness (2 pts)
- Duration of symptoms
- 10-59 min (1 pt)
- >60 min (2 pts)
- DM (1 pt)
| Points |
Stroke Risk |
Two Days |
Seven Days |
90 Days |
| 0-3 |
Low |
1.0% |
1.2% |
3.1% |
| 4-5 |
Moderate |
4.1% |
5.9% |
9.8% |
| 6-7 |
High |
8.1% |
11.7% |
17.8% |
None with score <3 had CVA within one week in study
Background
- Ischemic
- Thrombosis
- Vasculitis
- Dissection
- Embolic
- Cardiac
- Carotids
- Vasospasm
- Hypotension (watershed)
DDx
- Hypoglycemia
- Infectious endocarditis
- Complex Migraine
- Peripheral cranial nerve lesions
- Seizure
Work-Up
- Head CT
- Labs
- CBC (thrombocytosis)
- Chemistry (hyponatremia)
- Coags
- ECG (a-fib)
- CXR
- ?MRI/MRA or ?Neuro labs (ESR?, lipids?)
Treatment
- Head of bed lowered
- Permissive hypertension
- NS 500cc bolus, then 150cc/hr (non-CHF/fluid overloaded)
- ASA
- Heparin if cardiac embolic source/a-fib (usually different vascular territories)
Disposition
Admission Criteria
AHA/ASA Guidelines
- Reasonable to hospitalize pts w/ TIA who present w/in 72 hr of symptom onset and have:
- ABCD2 score of ≥ 3
- ABCD2 score of 0-2 and uncertainty that diagnostic w/u can be completed w/in 2d as oupt
- ABCD2 score of 0-2 and other evidence that event was caused by focal ischemia
National Stroke Association
- Hospitalization for pts with first TIA w/in past 24-48hr
- Recommended admission for pts w/ the following:
- Crescendo TIA
- Duration of symptoms >1hr
- Symptomatic carotid stenosis >50%
- Known cardiac source of embolus
- Known hypercoaguable state
- High risk of early stroke after TIA
See Also
Source
- Stroke 2009;40[6]:2276