Objective Urgent evaluation and treatment of transient ischemic attack (TIA) patients in a dedicated TIA clinic may reduce the 90‐day stroke risk by 80%. ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) score and magnetic resonance imaging abnormalities help to identify patients at high risk of stroke. Our aim was to determine whether the use of transcranial Doppler (TCD) examination on arrival at the TIA clinic yields additional information that facilitates the identification of patients at high risk of stroke recurrence. Methods Between January 2003 and December 2007, 1,881 patients were admitted to SOS‐TIA clinic (a TIA clinic with around‐the‐clock access). Clinical and vascular assessment included TCD performed by a neurologist immediately after admission. Stroke prevention measures were initiated on arrival, in accordance with guidelines. All patients were followed for 1 year after presentation to the SOS‐TIA clinic. Results A total of 1,823 TCD examinations were performed within 4 hours of admission. Intracranial narrowing or occlusion was found in 8.8% of patients, and was independently associated with age, hypertension, and diabetes. After 1‐year follow‐up on best preventive therapy, the incidence of recurrent vascular events (intracranial revascularization for TIA recurrence, stroke, myocardial infarction, and vascular death combined) was 7.0% in patients with intracranial narrowing or occlusion and 2.4% in those without (log‐rank, p = 0.007). The hazard ratio of combined outcome for the presence of intracranial narrowing or occlusion was 2.29 (95% confidence interval [CI], 1.15‐4.56; p = 0.02) in multivariate analysis including age, gender, hypertension, and diabetes, and was 2.50 (95%CI, 1.24–5.05; p = 0.01) in multivariate analysis including ABCD2 score ≥4. Interpretation Immediate TCD examination on arrival at the TIA clinic is feasible and could help to identify patients at high risk of vascular events recurrence. This study supports a systematic intracranial vascular examination in the initial management of TIA. ANN NEUROL 2010;68:9–17
A 44-year-old premenopausal, nulliparous woman presented with a recently discovered 4 cm palpable mass in the upper outer quadrant of her right breast. She denied any skin changes, nipple discharge, or axillary adenopathy. She had no family history of breast cancer and has had no previous mammographic abnormalities or biopsies. On physical examination, the mass was palpable at the 10 o'clock position of the right breast. There were no nipple or skin changes, no cervical, supraclavicular, or axillary adenopathy, and no expressible nipple fluid. Diagnostic mammography was performed with radiopaque markers placed at the level of the palpable abnormality, located in the posterior aspect of the right upper outer quadrant and over the palpable mass. Her prior mammograms were performed at an outside institution and were unavailable for comparison. The film-screen mammographic views revealed a 4.0 ϫ 3.5 cm macrolobulated, hyperdense mass corresponding to the palpable area, a portion of which demonstrated ill-defined margins (Fig. 1). To further characterize the mass, sonography was performed and revealed a complex mass with a near-anechoic portion, suggesting a cystic or necrotic component. In addition, an eccentric 1.2 cm, more
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