Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association.

Feinberg, William M.; Albers, Greg; Barnett, H. J. M.; Biller, José; Caplan, Louis R.; Carter, L P; Hart, Robert G.; Hobson, Robert W.; Kronmal, Richard A.; Moore, William P.

doi:10.1161/01.cir.89.6.2950

Cited by 91 publications

(49 citation statements)

References 183 publications

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“…6 American Heart Association guidelines note the absence of any prospective data on when, if ever, hospitalization is indicated for patients with TIA. 7 Nonetheless, given the potentially devastating outcome of stroke after TIA, many authorities recommend emergent inpatient evaluation of most patients with recent TIA in an attempt to identify high-risk patients in need of specific preventative therapy. 8,9 Like clinicians caring for patients with acute chest pain, those caring for TIA patients "constantly maneuver between unnecessary admissions and premature discharges."…”

mentioning

confidence: 99%

Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack?

Cucchiara

Messé

Taylor

et al. 2006

Stroke

120

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Background and Purpose-A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score Ͻ4 reportedly indicates minimal short-term stroke risk. We evaluated this scoring system in an independent population. Methods-This was a prospective study of TIA patients (diagnosed by a neurologist using the classic Ͻ24-hour definition) hospitalized Ͻ48 hours from symptom onset. The primary outcome assessment consisted of dichotomization of patients into 2 groups. The high-risk group included patients with stroke or death within 90 days, Ն50% stenosis in a relevant artery, or a cardioembolic source warranting anticoagulation. All others were classified as low risk. Findings on diffusion-weighted MRI (DWI) were also evaluated when performed and patients classified as DWIϩ or DWIϪ. Results-Over 3 years, 117 patients were enrolled. Median time from symptom onset to enrollment was 25.2 hours (interquartile range 19.8 to 30.2). Overall, 26 patients (22%) were classified as high risk, including 2 strokes, 2 deaths, 15 with Ն50% stenosis, and 10 with cardioembolic source. The frequency of high-risk patients increased with ABCD score (0 to 1 13%; 2 8%; 3 17%; 4 27%; 5 26%; 6 30%; P for trendϭ0.11). ABCD scores in the 2 patients with stroke were 3 and 6. Of those who underwent MRI, 15 of 61 (25%) were DWIϩ, but this correlated poorly with ABCD score (0 to 1 17%; 2 10%; 3 36%; 4 24%; 5 13%; 6 60%; P for trendϭ0.24). Conclusions-Although the ABCD score has some predictive value, patients with a score Ͻ4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms.

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mentioning

confidence: 99%

Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack?

Cucchiara

Messé

Taylor

et al. 2006

Stroke

120

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“…1 These "ministrokes" are usually of short duration (from minutes to a few hours) and, therefore, are considered benign with no need for emergency workup. [2][3][4][5][6] The traditional concept of TIA adds to this belittlement, although the short-term risk for any adverse event after TIA, either cerebrovascular or cardiovascular, is greater than previously assumed, [7][8][9] and the long-term risk, too, is substantial. 8 -12 Because of this and the inability to differentiate TIA from stroke in the hyperacute stage, where thrombolysis is now the state-of-the-art emergency treatment, the term "brain attack" for both, either in combination with cerebral imaging information 13,14 or not, seems a more adequate approach to improve therapy, mandatory workup, and prediction of prognosis.…”

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confidence: 99%

Transient Ischemic Attacks Are More Than “Ministrokes”

Daffertshofer

Mielke

Pullwitt

et al. 2004

Stroke

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Background and Purpose-Transient ischemic attacks (TIAs) are warning signs of stroke. Recently, the hypothesis was raised that TIA bears a significant risk for death and dependence and requires the same complex diagnostic workup as a complete stroke. Methods-We prospectively collected pre-and in-hospital procedures, symptoms, outcome, complications, and therapies from a representative sample of all stroke-treating hospitals (nϭ82) in southwest Germany. Follow-up was attempted 6 months after discharge. End points were death or dependence in activities of daily living (Barthel Index Ͻ95, modified Rankin Scale (mRS) of 3 to 6, or institutionalization in a nursing home). Results-1380 TIA patients and 3855 stroke patients entered the database. During hospital stay, stroke incidence was 8%for TIA patients and another 5% within the first half-year. Similarly, for ischemic stroke (IS) patients these figures were 7% and 6% (PϾ0.05), respectively. Two percent of TIA patients died in hospital (5% afterward) compared with 9% of stroke patients (10% afterward, PϽ0.001). Seventeen percent TIA compared with 38% IS patients (PϽ0.05) were dependent at follow-up. Whereas an estimated preexisting deficit (mRS Ͼ2) was the strongest predictor for death or disability (baseline mRS odds ratio, 4.1; 95% CI, 2.3 to 7.2), admission to a stroke unit was a valid predictor for survival and independence (odds ratio, 0.4; 95% CI, 0.2 to 0.9). Conclusions-These data from a large, multicenter, nonselected, observational study underscore the "not so benign" prognosis for TIA patients. There is a relevant individual risk of early stroke, death, or disability in TIA patients. Management and treatment strategies are similar for both TIA and acute stroke.

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“…Therefore, it is imperative to start with the secondary preventive measures in all TIA patients (8,9,10). Except for antithrombotics and statins, the management includes control of the risk factors, such as arterial hypertension, coronary heart disease and diabetes mellitus.…”

Section: Treatmentmentioning

confidence: 99%

Transient ischemic attack in the vertebro-basilar circulation due to a hemodynamically significant variation – kinking of the extracranial section of the left vertebral artery

Wagnerova¹,

Goldenberg²

2013

BLL

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Abstract:We present a case report of a 74-year old female patient with the clinical diagnosis of transient ischemic attack (TIA) in the vertebro-basilar (VB) circulation, in whom we found bilateral variation of the extracranial section of vertebral arteries on ultrasound, on the left side to the extent of kinking. This fi nding was later confi rmed by magnetic resonance angiography (MRA). We discuss the presumed hemodynamic signifi cance of this variation and its etiological relation to the patient's clinical picture. Ultrasound examination of the carotid and vertebro-basilar circulations is an important examination technique contributing to an early detection of possible aetiology of the cerebral circulation disorders (Fig. 7 A transient ischemic attack (TIA) is an acute episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction. A group of cerebrovascular experts proposed a shift from the arbitrary time-based defi nition of TIA to a tissue-based defi nition in 2002 with a new defi nition for TIA as "a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of an acute infarction". (1) This proposed new defi nition was well received and endorsed by many clinicians. The American Heart Association and American Stroke Association (AHA/ASA) 2009 Guidelines endorsed this new defi nition, modifying it with the omission of the phrase "typically less than one hour," as there is no time cut-off that reliably distinguishes whether a symptomatic ischemic event will result in tissue infarction. The AHA/ASAendorsed defi nition of TIA is following: Transient ischemic attack (TIA) is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without an acute infarction (2).TIA in the vertebro-basilar (VB) circulation is characterized by vertigo, nausea, vomiting, double vision, ataxia, dysarthria, dysphagia and bilateral or alternating disturbances of movement or sensory functions. An isolated vertigo may be the initial symptom; however, a combination of symptoms is more typical (3).Atherosclerosis of the major vessels has been the cause of TIA in the VB circulation in 31 % of patients, followed by embolism from the heart (27 %), intra-arterial embolism (17 %), affection of the smaller vessels (16 %), and a number of more uncommon causes (9 %). Stenotic changes in the VB circulation may cause the symptom onset by a hemodynamic mechanism; frequently there are short, stereotypic, and predominantly orthostatic TIAs. Compression or stretching of the vertebral arteries due to the degenerative changes in the cervical spine, depending on position of the head, may also result in perfusion disturbances; retrofl ection, rotation, and their combination in particular, are of the highest risk (4). The ischemia often manifests itself at rest and early in the morning, when there usually is a physiological lowering of the ...

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Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association.

Cited by 91 publications

References 183 publications

Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack?

Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack?

Transient Ischemic Attacks Are More Than “Ministrokes”

Transient ischemic attack in the vertebro-basilar circulation due to a hemodynamically significant variation – kinking of the extracranial section of the left vertebral artery

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