Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack

Johnston, S. Claiborne; Rothwell, Peter M.; Nguyen‐Huynh, Mai N.; Giles, Matthew F.; Elkins, Jacob; Bernstein, Allan L.; Sidney, Stephen

doi:10.1016/s0140-6736(07)60150-0

Cited by 1,179 publications

(972 citation statements)

References 37 publications

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“…23,24 Furthermore, ischemic strokes of cardioembolic origin have the highest rate of recurrence, 11 and the same may be true for patients with TIA. Speech disturbance is a component of the ABCD 2 score, a tool developed to predict the risk of stroke after TIA, 25 even if an independent verification analysis has found this score to be inaccurate and nonspecific. 12 It is possible that the accuracy of scoring tools may be improved by including aphasia, only when it occurs in the absence of other deficits or studying other interactions between components of the score.…”

Section: Discussionmentioning

confidence: 99%

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Wasserman

Perry

Dowlatshahi

et al. 2015

CJEM

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Objective: A cardiac source is often implicated in strokes where the deficit includes aphasia. However, less is known about the etiology of isolated aphasia during transient ischemic attack (TIA). Our objective was to determine whether patients with isolated aphasia are likely to have a cardioembolic etiology for their TIA. Methods: We prospectively studied a cohort of TIA patients in eight tertiary-care emergency departments. Patients with isolated aphasia were identified by the treating physician at the time of emergency department presentation. Patients with dysarthria (i.e., a phonation disturbance) were not included. Potential cardiac sources for embolism were defined as atrial fibrillation on history, electrocardiogram, Holter monitor, atrial fibrillation on echocardiography, or thrombus on echocardiography. Results: Of the 2,360 TIA patients identified, 1,155 had neurological deficits at the time of the emergency physician assessment and were included in this analysis, and 41 had isolated aphasia as their only neurological deficit. Patients with isolated aphasia were older (73.9 ± 10.0 v. 67.2 ± 14.5 years; p = 0.003), more likely to have a history of heart failure (9.8% v. 2.6%; p = 0.027), and were twice as likely to have any cardiac source of embolism (22.0% v. 10.6%; p = 0.037). Conclusions: Isolated aphasia is associated with a high rate of cardioembolic sources of embolism after TIA. Emergency patients with isolated aphasia diagnosed with a TIA warrant a rapid and thorough assessment for a cardioembolic source. RÉSUMÉObjectif: L'origine cardiaque est souvent incriminée dans les accidents vasculaires cérébraux dans lesquels le déficit neurologique comprend de l'aphasie. Cependant, on connaît peu de choses sur la cause de l'aphasie isolée durant les accidents ischémiques transitoires (AIT). L'étude visait donc à déterminer si les patients atteints d'aphasie isolée étaient plus susceptibles de subir un AIT d'origine cardioembolique. Méthode: Il s'agit d'une étude prospective de cohortes, composées de patients qui ont subi un AIT et qui ont été examinés dans 8 services d'urgence (SU) de soins tertiaires. Ceux qui présentai-ent des signes d'aphasie isolée étaient reconnus par le médecin traitant au moment de la consultation au SU. Les malades souffrant de dysarthrie (c'est-à-dire de troubles de la phonation) ont été écartés. Les sources possibles d'embolie d'origine cardiaque comprenaient la mention d'antécédents de fibrillation auriculaire (FA) à l'anamnèse; la présence de FA à l'électrocardio-graphie, à l'enregistrement de Holter ou à l'échocardiographie; ou encore la présence de thrombus à l'échocardiographie. Résultats: Sur 2360 patients qui avaient subi un AIT, 1155 présentaient un déficit neurologique au moment de l'évalua-tion par l'urgentologue et ont été sélectionnés aux fins de l'analyse; parmi ceux-ci, 41 avaient comme seul déficit neurologique de l'aphasie isolée. Les patients atteints d'aphasie isolée étaient plus âgés que ceux qui étaient épargnés (73,9 ± 10,0 contre [c.] 67,2 ± 14,...

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Section: Discussionmentioning

confidence: 99%

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Wasserman

Perry

Dowlatshahi

et al. 2015

CJEM

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“…Categorization of ABCD 2 scores into 3 groups (0 to 3, 4 to 5, 6 to 7) were used as was done in the initial ABCD 2 publication. 1 Collection of all clinical and radiographic information, and final determination of outcome category, was performed blinded to results of biomarker testing.…”

Section: Methodsmentioning

confidence: 99%

“…1,2 Biomarkers indicating the presence of unstable atherosclerotic plaque might represent a useful supplement to improve risk prediction. Lipoproteinassociated phospholipase A 2 (Lp-PLA 2 ) and C-reactive protein are 2 candidate markers which have been associated with inflammation and plaque instability in histopathologic studies of the carotid arteries.…”

mentioning

confidence: 99%

Lipoprotein-Associated Phospholipase A ₂ and C-Reactive Protein for Risk-Stratification of Patients With TIA

Cucchiara

Messé

Sansing

et al. 2009

Stroke

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Background and Purpose-Lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is a marker of unstable atherosclerotic plaque, and is predictive of both primary and secondary stroke in population-based studies. Methods-We conducted a prospective study of patients with acute TIA who presented to the ED. Clinical risk scoring using the ABCD 2 score was determined and Lp-PLA 2 mass (LpPLA 2 -M) and activity (LpPLA 2 -A) and high-sensitivity C-reactive protein (CRP) were measured. The primary outcome measure was a composite end point consisting of stroke or death within 90 days or identification of a high-risk stroke mechanism requiring specific early intervention (defined as Ն50% stenosis in a vessel referable to symptoms or a cardioembolic source warranting anticoagulation

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“…Comparisons across studies point to a 90-day stroke risk ranging from 10 to 20% after TIA [17]. In response to this new knowledge, prediction scores have been developed and validated to facilitate better decisionmaking in the evaluation of imminent risk of stroke after TIA [18]. These scores could potentially be used to identify TIA patients who may require urgent admission, but have not yet been tested in a clinical trial.…”

Section: Prevalence and Incidencementioning

confidence: 99%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

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Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack

Cited by 1,179 publications

References 37 publications

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Lipoprotein-Associated Phospholipase A ₂ and C-Reactive Protein for Risk-Stratification of Patients With TIA

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

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Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack

Cited by 1,179 publications

References 37 publications

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Lipoprotein-Associated Phospholipase A 2 and C-Reactive Protein for Risk-Stratification of Patients With TIA

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

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Lipoprotein-Associated Phospholipase A ₂ and C-Reactive Protein for Risk-Stratification of Patients With TIA