Transient ischemic attack

Background

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

Prognosis

• ABCD2 Score
  • 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

• See CVA#Causes

DDx

• See CVA#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)

Treatment

1. Head of bed lowered
2. Permissive hypertension
3. NS 500cc bolus, then 150cc/hr (non-CHF/fluid overloaded)
4. ASA
5. Heparin if cardiac embolic source/a-fib (usually different vascular territories)

Disposition

Admission Criteria

AHA/ASA Guidelines

• 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

National Stroke Association

• Hospitalization for pts with first TIA w/in past 24-48hr
• Recommended admission for pts w/ the following:
  • 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

See Also

• CVA (Main)

Source

• Stroke 2009;40[6]:2276