2014 Preventing Stroke In Pts With Stroke and Transient Ischemic Attack (TIA) And References That Cite The Article

Posted on March 5, 2016 by Tom Wade MD

The key to prevention of a future stroke when the diagnosis of transient ischemic attack (TIA)* or stroke is made is to determine the urgency of making the diagnosis by using the ABCD2 score. And then promptly obtain tests that will allow you to determine the presumed mechanism of the TIA so you can begin the appropriate preventive therapy.              *TIA is a purely clinical diagnosis based on the history as the patient is normal at the              time of the exam.

Studies that are relevant to the determination of the etiology of a transient ischemic attack can include a CT scan of the head without contrast (to look for intracranial bleed), an electrocardiogram (to look for arrhythmias  and evidence of heart damage), CT Angiogram of the neck and intracranial vessels to look for severe vascular disease), a diffusion weighted MRI of the brain to look for previous silent cerebrovascular accidents, and other tests such as Holter, event recorder, and lab tests.

Other tests might also include a transthoracic or transesophageal echocardiogram.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack – A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [Link is to Full Text PDF] [PubMed Abstract]. The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Stroke. 2014 Jul;45(7):2160-236. doi: 10.1161/STR.0000000000000024. Epub 2014 May 1.

Erratum in
Correction. [Stroke. 2015]
Abstract
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
© 2014 American Heart Association, Inc.

The following articles cite the above (as of 3-5-2016)

Articles citing this article

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(4) Diagnosis of Transient Ischemic Attack (TIA) Using the ABCD2 Score from the Ischemic Stroke Module of the Emergency Neurological Life Support Course. Posted on September 11, 2015 by Tom Wade MD

(5) Causes of Transient Blurred Vision. Posted on July 8, 2013 by Tom Wade M

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