Transient ischemic attack: Difference between revisions
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== Background == | == Background == | ||
*'''New Definition:''' a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. <ref name="Albers">Albers GW, et al. The TIA Working Group. Transient ischemic attack: proposal for a new definition. N Engl J Med. 2002; 347:1713–1716.</ref> | *'''New Definition:''' a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. <ref name="Albers">Albers GW, et al. The TIA Working Group. Transient ischemic attack: proposal for a new definition. N Engl J Med. 2002; 347:1713–1716.</ref> | ||
*Should be viewed as analogous to unstable angina | **Should be viewed as analogous to unstable angina | ||
*'''Classic Definition:''' A sudden, focal neurologic deficit that lasts for less than 24 hours, is presumed to be of vascular origin, and is confined to an area of the brain or eye perfused by a specific artery<ref name="Albers"></ref> | *'''Classic Definition:''' A sudden, focal neurologic deficit that lasts for less than 24 hours, is presumed to be of vascular origin, and is confined to an area of the brain or eye perfused by a specific artery<ref name="Albers"></ref> | ||
Revision as of 18:14, 11 February 2015
Background
- New Definition: a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. [1]
- Should be viewed as analogous to unstable angina
- Classic Definition: A sudden, focal neurologic deficit that lasts for less than 24 hours, is presumed to be of vascular origin, and is confined to an area of the brain or eye perfused by a specific artery[1]
ABCD2 Score[2]
- 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
Causes
- See CVA
DDx
- See CVA
Work-Up
- Head CT
- Labs
- CBC
- Chemistry
- Coags
- ECG (a-fib)
- CXR
- ?MRI/MRA or ?neuro labs (ESR, lipids)
Disposition
AHA/ASA Guidelines[3]
- 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
NSA Guidelines[4]
- Hospitalization for pts with first TIA w/in past 24-48hr
- Recommended admission for pts w/ the following:
- Crescendo TIA (more than three TIAs in 72hr period)
- Duration of symptoms >1hr
- Symptomatic carotid stenosis >50%
- Known cardiac source of embolus
- Known hypercoaguable state
- High risk of early stroke after TIA
External Links
See Also
Source
- Stroke 2009;40[6]:2276
- Tintinalli
Works Sited
- ↑ 1.0 1.1 Albers GW, et al. The TIA Working Group. Transient ischemic attack: proposal for a new definition. N Engl J Med. 2002; 347:1713–1716.
- ↑ Johnston SC, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack.Lancet. 2007; 369(9558):283-92.
- ↑ Easton JD, et al. Definition and evaluation of transient ischemic attack. A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009; 40:2276-2293.
- ↑ Johnston SC, et al. National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol. 2006; 60(3):301-13.