Transient ischemic attack: Difference between revisions

(ref added)
(ref and link added)
Line 3: Line 3:
*Should be viewed as analogous to unstable angina  
*Should be viewed as analogous to unstable angina  


===ABCD2 Score===
===ABCD2 Score<ref>Johnston SC, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack.Lancet. 2007; 369(9558):283-92.</ref>===
*Risk of stroke at 2d, 7d, and 90d from TIA
*Risk of stroke at 2d, 7d, and 90d from TIA
*Although prognostic, evidence-based admission thresholds have not been determined
*Although prognostic, evidence-based admission thresholds have not been determined
Line 79: Line 79:
**Known hypercoaguable state  
**Known hypercoaguable state  
**High risk of early stroke after TIA
**High risk of early stroke after TIA
== External Links ==
[http://www.mdcalc.com/abcd2-score-for-tia/ MDCalc ABCD2 Score]


== See Also ==
== See Also ==

Revision as of 17:02, 11 February 2015

Background

  • Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction[1]
  • Should be viewed as analogous to unstable angina

ABCD2 Score[2]

  • Risk of stroke at 2d, 7d, and 90d from TIA
  • Although prognostic, evidence-based admission thresholds have not been determined
  • Score
    • Age >60yr (1 pt)
    • BP (SBP >140 OR diastolic >90) (1 pt)
    • Clinical Features
      • Isolated speech disturbance (1 pt)
      • Unilateral weakness (2 pts)
    • Duration of symptoms
      • 10-59 min (1 pt)
      • >60 min (2 pts)
    • DM (1 pt)


Points
Stroke 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

Causes

DDx

Work-Up

  1. Head CT
  2. Labs
    1. CBC
    2. Chemistry
    3. Coags
  3. ECG (a-fib)
  4. CXR
  5. ?MRI/MRA or ?neuro labs (ESR, lipids)

Disposition

AHA/ASA Guidelines[3]

  • Reasonable to hospitalize pts w/ TIA who present w/in 72 hr of symptom onset and have:
    • ABCD2 score of ≥ 3
    • ABCD2 score of 0-2 and uncertainty that diagnostic w/u can be completed w/in 2d as oupt
    • ABCD2 score of 0-2 and other evidence that event was caused by focal ischemia

NSA Guidelines[4]

  • Hospitalization for pts with first TIA w/in past 24-48hr
  • Recommended admission for pts w/ the following:
    • Crescendo TIA (more than three TIAs in 72hr period)
    • Duration of symptoms >1hr
    • Symptomatic carotid stenosis >50%
    • Known cardiac source of embolus
    • Known hypercoaguable state
    • High risk of early stroke after TIA

External Links

MDCalc ABCD2 Score

See Also

Source

  • Stroke 2009;40[6]:2276
  • Tintinalli

Works Sited

  1. Albers GW, et al. The TIA Working Group. Transient ischemic attack: proposal for a new definition. N Engl J Med. 2002; 347:1713–1716.
  2. Johnston SC, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack.Lancet. 2007; 369(9558):283-92.
  3. Easton JD, et al. Definition and evaluation of transient ischemic attack. A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009; 40:2276-2293.
  4. Johnston SC, et al. National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol. 2006; 60(3):301-13.