Transient ischemic attack: Difference between revisions
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== | ==Background== | ||
*Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction | |||
== Background == | == Background == | ||
#Ischemic | #Ischemic | ||
##Thrombosis | ##Thrombosis | ||
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== Work-Up == | == Work-Up == | ||
#[[Head CT]] | #[[Head CT]] | ||
#Labs | #Labs | ||
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== Treatment == | == Treatment == | ||
#Head of bed lowered | #Head of bed lowered | ||
#Permissive hypertension | #Permissive hypertension | ||
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== Disposition == | == Disposition == | ||
===AHA/ASA Guidelines=== | ===AHA/ASA Guidelines=== | ||
Reasonable to hospitalize patients with TIA who present w/in 72 hr of symptom onset and meet any of the following criteria: | Reasonable to hospitalize patients with TIA who present w/in 72 hr of symptom onset and meet any of the following criteria: | ||
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== Source == | == Source == | ||
*Stroke 2009;40[6]:2276 | |||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 06:49, 28 September 2011
Background
- Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction
Background
- Ischemic
- Thrombosis
- Vasculitis
- Dissection
- Embolic
- Cardiac
- Carotids
- Vasospasm
- Hypotension (watershed)
DDx
- Hypoglycemia
- Infectious endocarditis
- Complex Migraine
- Peripheral cranial nerve lesions
- Seizure
Work-Up
- Head CT
- Labs
- CBC (thrombocytosis)
- Chemistry (hyponatremia)
- Coags
- ECG (a-fib)
- CXR
- ?MRI/MRA or ?Neuro labs (ESR?, lipids?)
Treatment
- Head of bed lowered
- Permissive hypertension
- NS 500cc bolus, then 150cc/hr (non-CHF/fluid overloaded)
- ASA
- Heparin if cardiac embolic source/a-fib (usually different vascular territories)
Disposition
AHA/ASA Guidelines
Reasonable to hospitalize patients with TIA who present w/in 72 hr of symptom onset and meet any of the following criteria:
- ABCD2 score of ≥ 3
- ABCD2 score of 0-2 and uncertainty that the diagnostic workup can be completed within two days as an outpatient
- ABCD2 score of 0-2 and other evidence that the event was caused by focal ischemia
ABCD2 SCORE
- Age > 60 (1 pt)
- Blood pressure (SBP >140 OR diastolic >90) (1 pt)
- Clinical Features
- unilateral weakness (2 pt)
- isolated speech disturbance (1 pt)
- Duration of symptoms
- >60 min (2 pt)
- 10-59 min (1 pt)
- Diabetes (1 pt)
| Points |
Risk |
Two Days |
Seven Days |
90 Days |
| 0-3 |
Low |
1.0% |
1.2% |
3.1% |
| 4-5 |
Moderate |
4.1% |
5.9% |
9.8% |
| 6-7 |
High |
8.1% |
11.7% |
17.8% |
None with score < 3 had CVA within one week in study
National Stroke Association
Hospitalization for pts with first TIA w/in past 24-48 hours, and is generally recommended for pts with the following conditions:
- Crescendo TIA
- Duration of symptoms > 1hr
- Symptomatic carotid stenosis > 50%
- Known cardiac source of embolus
- Known hypercoaguable state
- High risk of early stroke after TIA
TIA ADMIT (nmlly neg sy; <1hr)
- any Johnson criteria
- <1 wk from onset
See Also
Source
- Stroke 2009;40[6]:2276