Transient ischemic attack: Difference between revisions
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None with score <3 had CVA within one week in study
None with score <3 had CVA within one week in study
===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


=== AHA/ASA Guidelines ===
==== National Stroke Association ====
 
*Hospitalization for pts with first TIA w/in past 24-48hr
Reasonable to hospitalize patients with TIA who present w/in 72 hr of symptom onset and meet any of the following criteria:
*Recommended admission for pts w/ the following:
 
**Crescendo TIA  
#ABCD2 score of ≥ 3
**Duration of symptoms >1hr  
#ABCD2 score of 0-2 and uncertainty that the diagnostic workup can be completed within two days as an outpatient
**Symptomatic carotid stenosis >50%  
#ABCD2 score of 0-2 and other evidence that the event was caused by focal ischemia
**Known cardiac source of embolus  
 
**Known hypercoaguable state  
 
**High risk of early stroke after TIA
 
=== National Stroke Association ===
 
Hospitalization for pts with first TIA w/in past 24-48 hours, and is generally recommended for pts with the following conditions:  
 
#Crescendo TIA  
#Duration of symptoms &gt; 1hr  
#Symptomatic carotid stenosis &gt; 50%  
#Known cardiac source of embolus  
#Known hypercoaguable state  
#High risk of early stroke after TIA
 
TIA ADMIT (nmlly neg sy; &lt;1hr)
 
#any Johnson criteria
#&lt;1 wk from onset


== See Also ==
== See Also ==
 
*[[CVA (Main)]]  
[[CVA (Main)]]  


== Source  ==
== Source  ==
*Stroke 2009;40[6]:2276
*Stroke 2009;40[6]:2276


[[Category:Neuro]]
[[Category:Neuro]]

Revision as of 04:27, 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
    • 90-day stroke risk after TIA is 9.5%

Background

  1. Ischemic
    1. Thrombosis
    2. Vasculitis
    3. Dissection
  2. Embolic
    1. Cardiac
    2. Carotids
  3. Vasospasm
  4. Hypotension (watershed)

DDx

  1. Hypoglycemia
  2. Infectious endocarditis
  3. Complex Migraine
  4. Peripheral cranial nerve lesions
  5. Seizure

Work-Up

  1. Head CT
  2. Labs
    1. CBC (thrombocytosis)
    2. Chemistry (hyponatremia)
    3. Coags
  3. ECG (a-fib)
  4. CXR
  5.  ?MRI/MRA or ?Neuro labs (ESR?, lipids?)

Treatment

  1. Head of bed lowered
  2. Permissive hypertension
  3. NS 500cc bolus, then 150cc/hr (non-CHF/fluid overloaded)
  4. ASA
  5. Heparin if cardiac embolic source/a-fib (usually different vascular territories)

Disposition

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

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
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