Transient Ischaemic Attack (TIA) (original) (raw)
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Preventing strokes: the assessment and management of people with transient ischaemic attack
The New Zealand medical journal, 2009
This review is a summary of the New Zealand guideline for the management of Transient Ischaemic Attack (TIA). TIA is a medical emergency and warrants urgent attention. The risk of early stroke following TIA may be as high as 12% at 7 days, and 20% at 90 days, with half of these strokes occurring within the first 48 hours. All people with suspected TIA should be assessed at initial point of health care contact for their risk of stroke. Diagnosis of TIA is more likely to be correct if the history confirms: sudden onset of symptoms, with maximal neurological deficit at onset; symptoms typical of focal loss of brain function such as unilateral weakness or speech disturbance; and rapid recovery, usually within 30-60 minutes. The ABCD2 score is a tool that assists with diagnosis and identifies people most at risk of stroke after TIA. People at high risk of stroke require urgent specialist assessment as soon as possible but definitely within 24 hours. This includes those with ABCD2 scores ...
Background: The ABCD 2 clinical prediction rule is a seven point summation of clinical factors independently predictive of stroke risk. The purpose of this cohort study is to validate the ABCD 2 rule in a Bulgarian hospital up to three years after TIA. Methods: All consecutive admissions to an emergency department with symptoms of a first TIA were included. Baseline data and clinical examinations including the ABCD 2 scores were documented by neurologists. Discrimination and calibration performance was examined using ABCD 2 cut-off scores of ≥3, ≥4 and ≥5 points, consistent with the international guidelines. The Hosmer-Lemeshow test was used to examine calibration between the observed and expected outcomes as predicted by ABCD 2 score within the logistic regression analysis. Results: Eighty-nine patients were enrolled to the study with a mean age of 63 years (+/− 12 years). Fifty-nine percent (n = 53) of the study population was male. Seven strokes (7 · 8%) occurred within the first year and six further strokes within the three-year follow-up period. There was no incident of stroke within the first 90 days after TIA. The rule demonstrated good predictive (OR = 1 · 58, 95% CI 1 · 09-2 · 29) and discriminative performance (AUC ROC = 0 · 72, 95% CI 0 · 58-0 · 86), as well as a moderate calibration performance at three years.
Transient ischaemic attacks: "mini-strokes" with major but preventable consequences
The New Zealand medical journal, 2013
Transient ischaemic attack (TIA) can be defined as symptoms consistent with stroke that resolve within 24 hours. The public and many health professionals refer to TIAs as 'mini-strokes', terminology that belies their potentially serious prognosis. Although people make a full recovery from a TIA, acute ischaemic lesions revealed on MRI scans occur in just under half of patients.
Transient Ischaemic Attack in the Acute Setting – Diagnosis, Management and Treatment
European Neurological Review, 2008
More than 700,000 acute strokes 1 and 300,000 transient ischaemic attacks (TIAs) 2,3 occur annually in the US. It is estimated that between 15 and 26% of acute stroke cases have a prior history of TIA. 4 TIAs are important because they are associated with high short-term risk of both stroke and cardiac events. In a widely quoted emergency department (ED) study of over 1,700 TIA cases from California, the three-month stroke risk was found to be 10.5%. 5 A recent meta-analysis of 11 TIA cohort studies found that the summary estimate for the 90-day stroke risk was 9.2%very similar to the Californian study. 6 This meta-analysis also confirmed that most of this stroke risk occurs in the first few days after the TIA event; the risk of stroke was 3.5% at two days and 8.0% at 30 days. 6 Similar findings were found in another recent meta-analysis of 18 cohort studies, which estimated that the seven-day risk of stroke was 5.2%. 7 Patients with TIA are also at high risk of other cardiovascular events. In a meta-analysis of 39 cohort studies, the annual risk of myocardial infarction and non-stroke vascular death following TIA was 2.2 and 2.1%, respectively. 8 These studies, which serve to illustrate the high risk of cardiovascular events following a TIA, suggest that patients suspected of having a TIA event require an expedited clinical work-up.
Diagnosis and initial management of transient ischaemic attack
Clinical Medicine, 2010
Transient ischaemic attack (TIA) is the sudden onset of focal neurological dysfunction of presumed vascular origin that, by definition, resolves within 24 hours (usually much sooner). Its importance as a predictor of completed stroke has only recently been recognised. Updated guidance on the recognition and management of TIA has recently been published as part of the National Clinical Guideline for Stroke. This is a concise version of the TIA component of the full guideline that recommends an urgent response to TIA to prevent subsequent stroke.
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2018
The Review of Transient Ischemic Attack Patients: An Experience of a Clinic about Diagnosis and Follow-up T ransient ischemic attack (TIA) is an entity characterized by short-term symptoms of acute, focal cerebral or monocular dysfunction that develops due to insufficient blood flow. Generally, episodes lasting less than 24 hours are considered as TIA. TIA is present in 10-5% of patients with ischemic stroke. [1-4] Eighteen percent of these patients experience a stroke within the first three months and half of them within the first 48 hours. [5] The importance of this condition is that secondary prophylactic therapies to be initiated can prevent stroke. Therefore, the risk of near-term stroke in patients is determined by ABCD2 scoring (age, blood pressure, type of TIA, duration) after TIA, so possible Objectives: Transient Ischemic Attack (TIA) is due to a temporary lack of adequate blood and oxygen to the brain. TIAs typically last less than 24 hours. 10-15% of ischemic stroke patients have a history of TIA. 18% of them experience an ischemic stroke within 90 days, and the ABCD2 scoring system is used to estimate the risk. Our study aims to investigate the risk factors, the etiology, the lesion occurrence on MRI and the near-term risk of stroke of patients on whom TIA was diagnosed. Methods: In this study, 124 patients were included between January 2012 and January 2018. Sixty-eight of the 124 patients were male. The history of patients was questioned; systemic and neurological examinations were made. The stroke risk factors and TIA duration were noted and ABCD2 scores were calculated. All the patients' blood samples, including glucose and lipid profile, were studied. They received CT, DWI MRI, electrocardiography, transthoracic echocardiography, ultrasound and/or MR angiography of the cervical arteries. Results: One hundred twenty-four patients were included in this study, and 56 patients were female. The mean age was 63.04±16.77. Hypertension was the most common risk factor (50.8%). Twenty-seven patients were on antithrombotic; six patients were on anticoagulant therapy, while 91 patients were not receiving any antiaggregan therapy. ABCD2 scores were significantly higher on the antithrombotic therapy group (p=0.019). In 52 patients ABCD2 score was below 4, and in 72 patients, the score was greater than 4. In 67.7% of patients, no etiology was found. An ischemic lesion was detected in 16.9% of the patients. 58 % of the patients were discharged on anticoagulant therapy. Five patients developed ischemic stroke. Conclusion: The risk factors of ischemic stroke and TIAs are similar factors. The etiology of TIAs cannot be found out in most of the patients. Thus, the patients are discharged with oral anticoagulant treatment.
Emergency Medicine Journal, 2007
Background: Recent evidence shows a substantial short-term risk of ischaemic stroke after transient ischaemic attack (TIA). Identification of patients with TIA with a high short-term risk of stroke is now possible through the use of the ''ABCD Score'', which considers age, blood pressure, clinical features and duration of symptoms predictive of stroke. Aim: To evaluate the ability of dichotomising the ABCD Score to predict stroke at 7 and 90 days in a population with TIA presenting to an emergency department. Methods: A retrospective audit was conducted on all probable or definite TIAs presenting to the emergency department of a metropolitan hospital from July to December 2004. The ABCD Score was applied to 98 consecutive patients with TIA who were reviewed for subsequent strokes within 90 days. Patients obtaining an ABCD Score >5 were considered to be at high risk for stroke. Results: Dichotomising the ABCD Score categorised 48 (49%) patients with TIA at high risk for stroke (ABCD Score >5). This high-risk group contained all four strokes that occurred within 7 days (sensitivity 100% (95% confidence interval (CI) 40% to 100%), specificity 53% (95% CI 43% to 63%), positive predictive value 8% (95% CI 3% to 21%) and negative predictive value 100% (95% CI 91% to 100%)), and six of seven occurring within 90 days (sensitivity 86% (95% CI 42% to 99%), specificity 54% (95% CI 43% to 64%), positive predictive value 12.5% (95% CI 5% to 26%) and negative predictive value 98% (95% CI 88% to 100%)). Removal of the ''age'' item from the ABCD Score halved the number of false-positive cases without changing its predictive value for stroke. Conclusion: In this retrospective analysis, dichotomising the ABCD Score was overinclusive but highly predictive in identifying patients with TIA at a high short-term risk of stroke. Use of the ABCD Score in the emergency care of patients with TIA is simple, efficient and provides a unique opportunity to prevent stroke in this population of patients.
Internal Medicine Journal, 2012
Background: The ABCD 2 stroke risk score is recommended in national guidelines for stratifying care in transient ischaemic attack (TIA) patients, based on its prediction of early stroke risk. We had become concerned about the score accuracy and its clinical value in modern TIA cohorts. Methods: We identified emergency department-diagnosed TIA at two hospitals over 3 years (2004-2006). Cases were followed for stroke occurrence and ABCD 2 scores were determined from expert record review. Sensitivity, specificity and positive predictive values (PPV) of moderate-high ABCD 2 scores were determined. Results: There were 827 indexed TIA diagnoses and record review was possible in 95.4%. Admitted patients had lower 30-day stroke risk (n = 0) than discharged patients (n = 7; 3.1%) (P < 0.0001). There was no significant difference in proportion of strokes between those with a low or moderate-high ABCD 2 score at 30 (1.2 vs 0.8%), 90 (2.0 vs 1.9%) and 365 days (2.4 vs 2.4%) respectively. At 30 days the sensitivity, specificity and PPV of a moderate-high score were 57% (95% confidence interval (CI) 25.0-84.2), 32.2% (95% CI 29.1-35.6) and 0.75% (95% CI 0.29-1.91) respectively. Conclusions: Early stroke risk was low after an emergency diagnosis of TIA and significantly lower in admitted patients. Moderate-high ABCD 2 scores did not predict early stroke risk. We suggest local validation of ABCD 2 before its clinical use and a review of its place in national guidelines.
Transient Ischemic Attack: Clinical Features and Outcome
Journal of Biomedical and Clinical Research
SummaryA Transient Ischemic Attack (TIA) is a state of emergency and an independent risk factor for ischemic stroke. The social significance of the disease is determined, based on the probability of occurrence of subsequent cerebrovascular incidents and their frequency among groups. The purpose of the present study was to perform a comparative analysis of clinical features and outcome in patients with TIA for at least 24 months after onset had been registered, according to the pathogenesis and to ABCD (2) score. Two hundred and fifty-seven patients were monitored at the Neurology Clinic, First MHAT – Sofia after suffering an initial TIA. All subjects were studied using a clinical evaluation of pathogenetic mechanisms and an ABCD (2) algorithm. A diagnosis of TIA was confirmed by neuroimaging. The comparison between specific pathogenetic mechanisms demonstrated a statistically significant difference. Two TIA subgroups were involved – thromboembolic and cryptogenic (p<0.05). Also, ...