Transient Ischemic attack

 Excerpt from StatPearls, 2024

A transient ischemic attack (TIA) is a medical emergency. It is defined as a transient episode of neurologic dysfunction due to the focal brain, spinal cord, or retinal ischemia without acute infarction or tissue injury. The definition of a TIA has moved from time-based to tissue-based. A TIA typically lasts less than an hour, more often minutes. TIA can be considered a serious warning of an impending ischemic stroke; the risk is highest in the first 48 hours following a transient ischemic attack. Differentiating transient ischemic attack from other mimicking conditions is important. Transient ischemic attacks are usually associated with a focal neurologic deficit and/or speech disturbance in a vascular territory due to underlying cerebrovascular disease. It is always sudden in onset. Evaluation of TIA should be done urgently with imaging and laboratory studies to decrease the risk of subsequent strokes. The subsequent risk of TIA or ischemic stroke can be stratified with a simple clinical measure. Immediate multimodality therapeutic interventions should be initiated. These will include aggressive treatment of blood pressure, high-dose statin, antiplatelet therapy, blood sugar control, diet, and exercises. Specific underlying etiology needs to be managed accordingly. This treatment scheme may substantially reduce the risk of recurrent strokes or future TIA by at least 80%.

StatPearls - NCBI Bookshelf (nih.gov)

Transient Ischemic Attack - StatPearls - NCBI Bookshelf (nih.gov)

"The ABCD2 score is very important for predicting subsequent risks of TIA or stroke. The ABCD2 score was derived from providing a more robust prediction standard. The ABCD2 score includes age, blood pressure, clinical symptoms, duration, and diabetes.

Age: older than 60 years (1 point)
Blood pressure greater than or equal to 140/90 mmHg on first evaluation (1 point)
Clinical symptoms: a focal weakness with the spell (2 points) or speech impairment without weakness (1 point)
Duration greater than 60 min (2 points) or 10 min to 59 min (1 point)
Diabetes mellitus (1 point).

The 2-day risk of stroke was 0% for scores of 0 or 1, 1.3% for 2 or 3, 4.1% for 4 or 5, and 8.1% for 6 or 7. Most stroke centers will admit patients with TIA to the hospital for expedited management and observation if the score is 4, 5, or higher. For patients with a lower score, expedited evaluation and management are still warranted. This expedited approach has been proven to improve the outcome.[9]"