Minor ischemic stroke

Abstract

Background: Two-thirds of patients with stroke have mild deficits. The optimal triaging of these patients remains unclear. It is crucial to stratify patients based on who needs inpatient vs outpatient evaluation in a cost-effective manner. Methods: We reviewed the current literature (randomized trials, retrospective studies, case series, and case reports) on minor ischemic stroke and extrapolated evidence-based opinions and future directions on the management of minor ischemic stroke. Results:We provide evidence-based opinions and future directions on the approach to triaging patients with mild deficits based on the early risk of stroke recurrence, feasibility of outpatient diagnostic evaluation, and disabling deficits needing inpatient evaluation by physical and occupational therapy.Conclusions: Outpatient evaluation of patients with nondisabling minor stroke is potentially cost-effective after excluding large artery atherosclerosis and ensuring a rapid access outpatient evaluation. Larger studies on the cost-effectiveness and safety of this approach are necessary. Neurol Clin Pract 2016;6:157-163 I n population-and hospital-based studies, approximately two-thirds of ischemic stroke patients are found to have mild deficits.1 With the exception of being younger, patients with minor stroke have similar demographic characteristics as patients with moderate to severe stroke.1 On the other hand, the prevalence of TIA increases with age, ranging from 0.4% in adults between the ages of 45 and 64 years to 4.1% in those between 75 and 79 years. While the age, blood pressure, clinical, diabetes, duration (ABCD2) score is used to prognosticate risk of subsequent stroke and thereby triage patients with TIAs, the use of this score and others to triage patients with minor ischemic stroke is not validated. This review aims to provide an overview on the definition and outcome of patients with minor ischemic stroke with a focus on triaging and disposition.

Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

“…This is the first study to demonstrate corneal nerve and endothelial cell pathology in patients with TIA or minor IS, extending our previous findings in patients with major stroke [ 19 , 20 ]. Diabetes, hypertension, smoking, dyslipidemia [ 27 – 29 ], obesity [ 25 ] and metabolic syndrome [ 30 ] are known risk factors for stroke and are linked to cerebral white matter lesions and silent lacunar brain infarcts [ 31 ], but have limited prognostic value for recurrent stroke in patients with TIA and minor IS [ 4 ]. Impaired cerebral reactivity has been associated with the risk of subsequent stroke in patients with TIA [ 32 , 33 ], and smoking, hypertension, diabetes and cholesterol are related to altered CBF in patients with TIA and minor stroke [ 31 , 34 ].…”

“…Transient Ischemic Attack [ 1 ] and minor ischemic stroke (IS) share similar pathophysiology to stroke [ 3 ]. Although, the ABCD2 score has been used to prognosticate the risk of subsequent stroke [ 4 ], a meta-analysis showed that it does not reliably discriminate patients at low or high risk of recurrent stroke [ 5 ]. Similarly, neuroimaging may enhance the prognostic ability following TIA and minor stroke.…”

Rate and associated factors of transient ischemic attack misdiagnosis

“…A well-organized rapid access TIA clinic can relocate the care for low to medium-risk TIA patients from an inpatient hospital setting to an outpatient setting. There has been evidence that this practice is safe, cost-effective [[17], [18], [19], [20], [21], [22], [23]], and may improve the outcome [24]. Our results also indicated that only a small number of patients (4.3%) required an intervention or had a diagnosis (atrial fibrillation while on a heart monitor) that could have justified an inpatient hospitalization.…”

Minor Stroke and Transient Ischemic Attack: Research and Practice

“…While clinical risk prediction may be used to augment one’s gestalt of a patient’s short-term recurrent stroke risk, it should not be used as the sole determinant of disposition. Adopting a frontloaded, etiology-focused work-up that optimizes individual secondary prevention strategies is likely to be the best approach, regardless of location (hospital, clinic, or observation unit) ( 62 ).…”