Transient Ischemic Attack versus Transient Ischemic Attack Mimics: Frequency, Clinical Characteristics and Outcome

Amort, Margareth; Fluri, Felix; Schäfer, Juliane; Weisskopf, Florian; Katan, Mira; Burow, Annika; Bucher, Heiner C.; Bonati, Leo H.; Lyrer, Philippe; Engelter, Stefan T.

doi:10.1159/000327034

Cited by 87 publications

(92 citation statements)

References 78 publications

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“…The ascertainment of stroke events after TIA was carried out by face-to-face patient assessment or telephone interviews in 25 studies, 9,21,24,61,69,81,119,122,128,[132][133][134][137][138][139]144,[149][150][151][152]155,156,161,164,165 by medical records in 15 studies, 23,62,87,120,126,127,129,130,130,135,136,140,143,145,157,159 by mixed methods involving face-to-face assessment plus another method (i.e. telephone interviews, medical records, letters) in 11 studies, 65,131,[146][147][148]153,154,158,…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The 16 included studies 7,73,122,156,161,173,257,263,[265][266][267][268][269][270][271] varied in terms of their primary objectives. Three were population-based studies assessing the incidence of TIA in the general population in UK, the Netherlands and Spain (OCSP, Rotterdam Study and a community-based register in Segovia, respectively).…”

Section: Number Of Included/excluded Studiesmentioning

confidence: 99%

“…7,263,265 Eight studies focused on patients attending TIA clinics, 122,173,257,[266][267][268][269][270] and one study 183 enrolled patients from multiple settings as part of a population-based study, even although the final diagnosis was made in a TIA clinic (North Dublin TIA Study). Two were ED-based studies, 156,161 one included patients from ED and TIA clinics and reported the results for each setting separately and so contributed two independent data points, 73 and one recruited patients as part of a hospital-based clinical trial. 271 The 16 studies included a total of 14,542 participants, and all provided data on frequency of mimics compared with true TIA/minor stroke; 7,73,122,156,161,173,183,257,263,[265][266][267][268][269][270][271] 11 studies with a total of 3786 participants reported the main causes of non-CV events 7,122,156,161,173,263,[266][267][268][269][270] and five studies with a total of 85...…”

Section: Number Of Included/excluded Studiesmentioning

confidence: 99%

“…271 The 16 studies included a total of 14,542 participants, and all provided data on frequency of mimics compared with true TIA/minor stroke; 7,73,122,156,161,173,183,257,263,[265][266][267][268][269][270][271] 11 studies with a total of 3786 participants reported the main causes of non-CV events 7,122,156,161,173,263,[266][267][268][269][270] and five studies with a total of 8596 participants reported prognosis data. 122,156,265,270,271 One study deliberately excluded patients with some specific diagnoses other than TIA (i.e. migraine, epilepsy or vertigo).…”

Section: Number Of Included/excluded Studiesmentioning

confidence: 99%

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An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

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BackgroundPatients with transient ischaemic attack (TIA) or minor stroke need rapid treatment of risk factors to prevent recurrent stroke. ABCD2 score or magnetic resonance diffusion-weighted brain imaging (MR DWI) may help assessment and treatment.ObjectivesIs MR with DWI cost-effective in stroke prevention compared with computed tomography (CT) brain scanning in all patients, in specific subgroups or as ‘one-stop’ brain-carotid imaging? What is the current UK availability of services for stroke prevention?Data sourcesPublished literature; stroke registries, audit and randomised clinical trials; national databases; survey of UK clinical and imaging services for stroke; expert opinion.Review methodsSystematic reviews and meta-analyses of published/unpublished data. Decision-analytic model of stroke prevention including on a 20-year time horizon including nine representative imaging scenarios.ResultsThe pooled recurrent stroke rate after TIA (53 studies, 30,558 patients) is 5.2% [95% confidence interval (CI) 3.9% to 5.9%] by 7 days, and 6.7% (5.2% to 8.7%) at 90 days. ABCD2 score does not identify patients with key stroke causes or identify mimics: 66% of specialist-diagnosed true TIAs and 35–41% of mimics had an ABCD2 score of ≥ 4; 20% of true TIAs with ABCD2 score of < 4 had key risk factors. MR DWI (45 studies, 9078 patients) showed an acute ischaemic lesion in 34.3% (95% CI 30.5% to 38.4%) of TIA, 69% of minor stroke patients, i.e. two-thirds of TIA patients are DWI negative. TIA mimics (16 studies, 14,542 patients) make up 40–45% of patients attending clinics. UK survey (45% response) showed most secondary prevention started prior to clinic, 85% of primary brain imaging was same-day CT; 51–54% of patients had MR, mostly additional to CT, on average 1 week later; 55% omitted blood-sensitive MR sequences. Compared with ‘CT scan all patients’ MR was more expensive and no more cost-effective, except for patients presenting at > 1 week after symptoms to diagnose haemorrhage; strategies that triaged patients with low ABCD2 scores for slow investigation or treated DWI-negative patients as non-TIA/minor stroke prevented fewer strokes and increased costs. ‘One-stop’ CT/MR angiographic-plus-brain imaging was not cost-effective.LimitationsData on sensitivity/specificity of MR in TIA/minor stroke, stroke costs, prognosis of TIA mimics and accuracy of ABCD2 score by non-specialists are sparse or absent; all analysis had substantial heterogeneity.ConclusionsMagnetic resonance with DWI is not cost-effective for secondary stroke prevention. MR was most helpful in patients presenting at > 1 week after symptoms if blood-sensitive sequences were used. ABCD2 score is unlikely to facilitate patient triage by non-stroke specialists. Rapid specialist assessment, CT brain scanning and identification of serious underlying stroke causes is the most cost-effective stroke prevention strategy.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Number Of Included/excluded Studiesmentioning

confidence: 99%

Section: Number Of Included/excluded Studiesmentioning

confidence: 99%

Section: Number Of Included/excluded Studiesmentioning

confidence: 99%

See 2 more Smart Citations

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Wardlaw

Brazzelli

Miranda

et al. 2014

Health Technol Assess

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“…Se ha prestado poca atención a los pacientes y las condiciones que imitan los AIT. En un estudio de cohorte prospectivo de 2 años en Suiza, aproximadamente el 20% de los pacientes con sospecha de AIT en la presentación eran imitadores de AIT 29 . En el análisis univariante se han identificado varios factores que pueden ayudar a diferenciar entre ictus y PI.…”

Section: Discussionunclassified

Imitadores del ictus: un reto para el médico de urgencias

Valle

Lopera

Guillán

et al. 2014

Anales Sis San Navarra

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resuMenFundamento. Estudiar el número de pacientes diagnosticados de ictus en el servicio de urgencias hospitalario de un hospital de primer nivel y la proporción de estos pacientes que finalmente eran pseudoictus, así como describir y analizar las variables que pueden ayudar en el diagnóstico diferencial en los servicios de urgencias hospitalarios.Método. Estudio prospectivo de 9 meses. Se incluyeron todos los pacientes valorados en el servicio de Urgencias e ingresados con el diagnóstico de ictus. Se analizaron diversas variables clínicas que incluían la historia previa, la historia del evento actual, el examen físico general y neurológico y la clasificación del NIHSS y de la Oxforshire Community Stroke. El diagnóstico final se realizó por un panel de expertos con acceso a las características clínicas, estudios de imagen y otras pruebas. El análisis univariante y multivariado determinó las características que ayudan a distinguir los ictus de los pseudoictus.resultados. Se registraron 144 casos de ictus; la muestra final la conformó 140 pacientes. El diagnóstico final fue de ictus en 103 de 140 (73,6%) y de pseudoictus en el resto. Once variables predecían el diagnóstico en pacientes que se presentaban con sospecha de ictus: la edad superior a 70 años (p=0,012), una clasificación del NIHSS > 5, lograr una clasificación clínica (p=0,019) capaz de determinar el comienzo exacto (p=0,000), hallazgos vasculares anormales (p=0,014), desviación de la mirada (p=0.042), pérdida de la visión (p=0,052) y reflejo plantar extensor (p=0,025) favorecían el diagnóstico de ictus, mientras que las crisis comiciales (p=0,029), los síntomas neurológicos no congruentes con el territorio vascular (p=0,022) y los hallazgos anormales en otros sistemas (p=0,14) favorecían el diagnostico de pseudoictus.conclusión. Los pseudoictus constituyeron un tercio de los pacientes ingresados desde el servicio de Urgencias como ictus siendo la etiología muy variada. Lograr una historia clínica adecuada y un examen físico preciso es de gran importancia y puede ayudar a facultativos menos experimentados.Palabras claves. Pseudoictus. Ictus. Diagnóstico. abstract background. To study the number of patients diagnosed with a stroke in the emergency service of a first level hospital and the proportion of these patients who were finally stroke mimics, as well as to describe and analyze the variables that can help in differential diagnosis in hospital emergency services.

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Changes in Health-Related Quality of Life After Transient Ischemic Attack

et al. 2021

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IMPORTANCE Numerous studies have found that patients diagnosed with TIA have decreased health-related quality of life, which has been interpreted as suggesting that patients with TIA have residual symptoms after the event. Studies assessing health status in the same patients before and after an event are lacking but may allow a direct determination of the association of TIA with postevent health status. OBJECTIVETo examine patient-reported health before transient ischemic attack (TIA) among individuals diagnosed with this event and evaluate change in patient-reported health after the event overall and by TIA characterization subgroups. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among 236 patients with a clinical diagnosis of TIA from October 2015 to December 2017 in a large US health system that collects a patient-reported outcome measure in ambulatory setting as part of routine care. Included patients had patient-reported global health scale assessments completed as part of routine care before and after a TIA event. Data were analyzed from March through July 2020. MAIN OUTCOMES AND MEASURES The main outcome was Patient-Reported Outcome Measurement Information System Global Health (PROMIS GH) scale score before and after TIA. A change of 5 or more points in this score is considered clinically relevant. The secondary outcomes included change in patient-reported global health by clinical impression of the probability of a TIA event, pattern of neurological deficits, and short-term risk of stroke, as assessed by the ABCD2 score.RESULTS Among 263 patients who experienced TIA, mean (SD) age was 67.9 (13.4) years and 138 (52.5%) were women. The median (interquartile range) time between patient-reported global health scores was 152 (94-284) days. Mean (SD) baseline patient-reported global physical health and mental health scale summary scores were 43.4 (8.2) and 47.7 (9.7), respectively, and were statistically significantly decreased compared with the general population mean (SD) scores of 50 (10; P < .001) for physical and mental health. The difference between physical health summary score among study participants and the general population was clinically relevant. Mean (SD) summary scores were not statistically significantly different after the event compared with before the event overall (physical health: 44.1 [8.2], for a mean [SE] improvement of 0.65 [0.38] points; P = .09; mental health: 47.4 [9.1], for a mean [SE] worsening of 0.25 [0.38] points; P = .51) or within subgroups.CONCLUSIONS AND RELEVANCE These findings suggest that impaired health status among patients diagnosed with TIA reflect, at least in part, an impaired premorbid state of health. This study did not find that TIA events were associated with worsening of health status overall or within subgroups.

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Transient Ischemic Attack versus Transient Ischemic Attack Mimics: Frequency, Clinical Characteristics and Outcome

Cited by 87 publications

References 78 publications

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

Imitadores del ictus: un reto para el médico de urgencias

Changes in Health-Related Quality of Life After Transient Ischemic Attack

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