A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack

Rothwell, Peter M.; Giles, Matthew F.; Floßmann, Enrico; Lovelock, Caroline; Redgrave, Jessica; Warlow, C P; Mehta, Ziyah

doi:10.1016/s0140-6736(05)66702-5

Cited by 564 publications

(440 citation statements)

References 35 publications

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“…[1][2][3][4][5][6][7][8] Individual risk can be predicted to some extent by the use of clinical scores such as the ABCD2 score. 9 The occurrence of recurrent or dual TIAs has been proposed as an addition to the ABCD2 score to improve early stroke risk prediction after TIA.…”

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confidence: 99%

Population-based study of capsular warning syndrome and prognosis after early recurrent TIA

et al. 2012

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Objective: Many guidelines recommend emergency assessment for patients with Ն2 TIAs within 7 days, perhaps in recognition of the capsular warning syndrome. However, it is unclear whether all patients with multiple TIAs are at high early risk of stroke and whether treatable underlying pathologies are more prevalent in this group. Methods:We studied clinical characteristics, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and risk of stroke in 1,000 consecutive patients with incident and recurrent TIAs in a prospective, population-based study (Oxford Vascular Study).Results: Of 1,000 patients with TIAs, 170 had a further TIA within 7 days (105 within 24 hours).Multiple TIAs were not associated with carotid stenosis or atrial fibrillation, and much of the 10.6% (95% confidence interval [CI] 6.5Ϫ15.9) risk of stroke during the 7 days after the first TIA was due to patients with small-vessel disease (SVD) etiology (10 of 24 vs 8 of 146, odds ratio [OR] ϭ 12.3, 95% CI 3.7-41.9, p Ͻ 0.0001), particularly those with motor weakness (i.e., capsular warning syndrome) compared with hemisensory events (9 of 15 [60%], 95% CI 35.3-84.7 vs 1 of 9 [11.1%], 95% CI 0-31.7, p ϭ 0.03). The 7-day risk of stroke after a recurrent TIA was similar to the risk after a single TIA in patients with non-SVD TIA (8 of 146 [5.5%] vs 76 of 830 [9.2%], OR ϭ 0.58, 95% CI 0.25-1.3, p ϭ 0.20). Of the 9 patients with stroke after a capsular warning syndrome, all had the recurrent TIA within 24 hours after the first TIA, and the subsequent stroke occurred within 72 hours of the second TIA in 8. The ABCD2 scores of all preceding TIAs were Ն4 in all 9 patients with capsular warning syndrome before stroke.Conclusions: Capsular warning syndrome is rare (1.5% of TIA presentations) but has a poor prognosis (7-day stroke risk of 60%). Otherwise, recurrent TIA within 7 days is not associated with a greater stroke risk than that after a single TIA. Neurology

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confidence: 99%

Population-based study of capsular warning syndrome and prognosis after early recurrent TIA

et al. 2012

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“…4 In NASCET medically treated patients with symptomatic carotid stenosis on one side and a carotid occlusion on the other side were more than twice as likely to have an ipsilateral stroke at 2 years. 5 Our results extend these long-term observations to the very early period of a carotid artery becoming symptomatic in these patients.…”

Section: Discussionmentioning

confidence: 93%

Risk Factors for Early Recurrent Cerebral Ischemia Before Treatment of Symptomatic Carotid Stenosis

Kastrup

Ernemann²,

Nägele³

et al. 2006

Stroke

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Background and Purpose-In patients with a recently symptomatic carotid stenosis, surgical or interventional treatment is often delayed for weeks to months. Because therapy should be instituted as early as possible in patients at highest risk for recurrent ischemia, the aim of this study was to identify these individuals using clinical data and serial diffusion-weighted imaging (DWI). Methods-One hundred thirty-one patients (98 male; mean age 68Ϯ9 years) who had been referred to our department within 14 days (median; interquartile range, 4 to 36 days) after experiencing an ischemic event caused by a carotid stenosis were followed-up until carotid angioplasty and stenting. Risk factors predicting recurrent transient ischemic attack, stroke, or new DWI lesions were examined. Results-During a median follow-up period of 7 days (interquartile range, 5 to 13 days) no patient experienced a stroke, 4 patients (3.1%) developed a hemispherical transient ischemic attack, and in 15 patients (12%) new asymptomatic DWI lesions were present in the territory of the treated artery. Multivariable regression analysis revealed that motor symptoms (odds ratio, 5.6; 95% CI, 1.2 to 26.3; PϽ0.05) or the presence of a contralateral carotid occlusion (odds ratio, 4.6; 95% CI, 1.0 to 20.4; PϽ0.05) were significant independent predictors of further cerebral ischemic events before carotid angioplasty and stenting. Conclusions-In patients with a recently symptomatic carotid stenosis, the risk of early recurrent ischemia is highest in those with motor symptoms and in those with a contralateral carotid occlusion. In these high-risk patients urgent preventive treatment might be warranted. (Stroke. 2006;37:3032-3034.)

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“…5 The ABCD score is simple, fast and is suitable for screening the beginning of outpatient emergency patients, and includes age, blood pressure, clinical characteristics, and symptoms duration; ABCD score also focuses on the importance of unilateral limb weakness and duration of symptoms, obtaining good application. 7 ABCD score is used to predict TIA risk within 7d after stroke, and it can also be used to conduct health education to the public while allowing clinicians to rapidly screen increased risk in patients, thus guiding further treatment.…”

Section: Abcd Scorementioning

confidence: 99%

Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

Chen

et al. 2017

Int J Res Med Sci

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Transient Ischemic Attack (TIA) is a high-risk signal of acute ischemic cerebrovascular disease, indicates a significant increase in the risk of ischemic stroke, especially within 7 days. Risk assessment and stratification are important in patient with TIA. A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale. Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent. In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction. This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of the stroke risk in patients with TIA.

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A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack

Cited by 564 publications

References 35 publications

Population-based study of capsular warning syndrome and prognosis after early recurrent TIA

Population-based study of capsular warning syndrome and prognosis after early recurrent TIA

Risk Factors for Early Recurrent Cerebral Ischemia Before Treatment of Symptomatic Carotid Stenosis

Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

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