Stroke and Transient Ischemic Attack are diagnoses that confers increased risk of of future stroke. The prompt diagnosis of TIA allows the physician to begin therapy that may markedly reduce the risk of a subsequent stroke.
Acute stroke will present to the emergency department. But transient ischemic attack patients frequently present to primary care offices some time after the event.
And a patient who has experienced a transient ischemic attack is at markedly increased risk in the near future.
Transient ischemic attack is a diagnosis made by history. Patients with the diagnosis require prompt evaluation so that the appropriate preventive measures can be initiated.
Reference (1) below describes the diagnostic evaluation of a patient with transient ischemic attack. The abstract of that article is excellent and I have included it following the citation.
Once the presumed etiology of the transient ischemic attack has been determined, secondary prevention can be begun based on the etiology.
References (2), Executive Summary, and (3), Full Guidelines, provide detailed recommendations for preventive therapy following transient ischemic attack and stroke.
Reference (4) is about using the ABCD2 score in evaluation of transient ischemic attack.
Reference (5) discusses transient blurred vision which can be due to a transient ischemic attack. However, there are other causes of transient blurred vision that also require prompt diagnosis for preventive therapy.
Resources:
(1) Definition and Evaluation of Transient Ischemic Attack
A Scientific Statement for Healthcare Professionals [PubMed Abstract] [Full Text HTML] [Full Text PDF] 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. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009 Jun;40(6):2276-93. doi: 10.1161/STROKEAHA.108.192218. Epub 2009 May 7.
Abstract
This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD(2) score >or=3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis.
(2) Executive Summary: 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]. 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
(3) 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.
(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 MD
