Transient ischemic attack natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Transient ischemic attack}} | {{Transient ischemic attack}} | ||
{{CMG}}{{AE}}{{AA}} | |||
==Overview== | |||
{{ | If left untreated, the symptoms of transient ischemic attack may subside with in few hours. However, there is increased risk of stroke in these patients in future. The risk is highest in the next within hours and subsequently decreases after days, weeks to months.<ref name="pmid21640301">{{cite journal| author=Sorensen AG, Ay H| title=Transient ischemic attack: definition, diagnosis, and risk stratification. | journal=Neuroimaging Clin N Am | year= 2011 | volume= 21 | issue= 2 | pages= 303-13, x | pmid=21640301 | doi=10.1016/j.nic.2011.01.013 | pmc=3109304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21640301 }} </ref>The prognosis of TIA depends on the possibilty of developing ischemic stroke in the future. There is 11 percent increased risk of ischemic stroke in patients having TIA for next seven days and 25-29% in next five years.<ref name="pmid22972645">{{cite journal| author=Paul NL, Simoni M, Chandratheva A, Rothwell PM| title=Population-based study of capsular warning syndrome and prognosis after early recurrent TIA. | journal=Neurology | year= 2012 | volume= 79 | issue= 13 | pages= 1356-62 | pmid=22972645 | doi=10.1212/WNL.0b013e31826c1af8 | pmc=PMC3448742 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972645 }} </ref> This is especially true in patients with TIA due to small-vessel disease (SVD) etiology with motor weakness (capsular warning syndrome).<ref name="pmid22972645"/> | ||
==Natural History== | |||
If left untreated, the symptoms of transient ischemic attack may subside with in few hours. However, there is increased risk of stroke in these patients in future. The risk is highest in the next within hours and subsequently decreases after days, weeks to months.<ref name="pmid21640301">{{cite journal| author=Sorensen AG, Ay H| title=Transient ischemic attack: definition, diagnosis, and risk stratification. | journal=Neuroimaging Clin N Am | year= 2011 | volume= 21 | issue= 2 | pages= 303-13, x | pmid=21640301 | doi=10.1016/j.nic.2011.01.013 | pmc=3109304 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21640301 }} </ref> | |||
==Complications== | ==Complications== | ||
Complications of TIA include: | Complications of TIA include:<ref name="pmid: 27096581">{{cite journal| author=Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P et al.| title=One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. | journal=N Engl J Med | year= 2016 | volume= 374 | issue= 16 | pages= 1533-42 | pmid=: 27096581 | doi=10.1056/NEJMoa1412981 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27096581 }} </ref><ref name="pmid3109304">{{cite journal| author=Schuknecht HF| title=Temporal bone collections in Europe and the United States. Observations on a productive laboratory, pathologic findings of clinical relevance, and recommendations. | journal=Ann Otol Rhinol Laryngol Suppl | year= 1987 | volume= 130 | issue= | pages= 1-19 | pmid=3109304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3109304 }} </ref><ref name="pmid22193354">{{cite journal| author=Jacquin A, Aboa-Eboulé C, Rouaud O, Osseby GV, Binquet C, Durier J et al.| title=Prior transient ischemic attack and dementia after subsequent ischemic stroke. | journal=Alzheimer Dis Assoc Disord | year= 2012 | volume= 26 | issue= 4 | pages= 307-13 | pmid=22193354 | doi=10.1097/WAD.0b013e3182420b2c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22193354 }} </ref><ref name="pmid25269762">{{cite journal| author=Broomfield NM, Quinn TJ, Abdul-Rahim AH, Walters MR, Evans JJ| title=Depression and anxiety symptoms post-stroke/TIA: prevalence and associations in cross-sectional data from a regional stroke registry. | journal=BMC Neurol | year= 2014 | volume= 14 | issue= | pages= 198 | pmid=25269762 | doi=10.1186/s12883-014-0198-8 | pmc=4189556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25269762 }} </ref><ref name="pmid18617658">{{cite journal| author=Coutts SB, Hill MD, Campos CR, Choi YB, Subramaniam S, Kosior JC et al.| title=Recurrent events in transient ischemic attack and minor stroke: what events are happening and to which patients? | journal=Stroke | year= 2008 | volume= 39 | issue= 9 | pages= 2461-6 | pmid=18617658 | doi=10.1161/STROKEAHA.107.513234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617658 }} </ref> | ||
*Ischemic stroke | *Ischemic stroke | ||
*Hemorrhagic stroke | *Hemorrhagic stroke | ||
* | *Dementia | ||
* | *Recurrent TIA | ||
*Anxiety | *Anxiety | ||
==Prognosis== | ==Prognosis== | ||
The prognosis of TIA depends on the possibilty of developing ischemic stroke in the future. There is 11 percent increased risk of ischemic stroke in patients having TIA for next seven days and 25-29% in next five years.<ref name="pmid22972645">{{cite journal| author=Paul NL, Simoni M, Chandratheva A, Rothwell PM| title=Population-based study of capsular warning syndrome and prognosis after early recurrent TIA. | journal=Neurology | year= 2012 | volume= 79 | issue= 13 | pages= 1356-62 | pmid=22972645 | doi=10.1212/WNL.0b013e31826c1af8 | pmc=PMC3448742 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972645 }} </ref> This is especially true in patients with TIA due to small-vessel disease (SVD) etiology with motor weakness (capsular warning syndrome).<ref name="pmid22972645"/> | The prognosis of TIA depends on the possibilty of developing ischemic stroke in the future. There is 11 percent increased risk of ischemic stroke in patients having TIA for next seven days and 25-29% in next five years.<ref name="pmid22972645">{{cite journal| author=Paul NL, Simoni M, Chandratheva A, Rothwell PM| title=Population-based study of capsular warning syndrome and prognosis after early recurrent TIA. | journal=Neurology | year= 2012 | volume= 79 | issue= 13 | pages= 1356-62 | pmid=22972645 | doi=10.1212/WNL.0b013e31826c1af8 | pmc=PMC3448742 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972645 }} </ref> This is especially true in patients with TIA due to small-vessel disease (SVD) etiology with motor weakness (capsular warning syndrome).<ref name="pmid22972645"/> | ||
The ABCD<sup>2</sup> score can predict likelihood of subsequent [[stroke]].<ref name="pmid17258668">{{cite journal |author=Johnston SC, Rothwell PM, Nguyen-Huynh MN, ''et al'' |title=Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack |journal=Lancet |volume=369 |issue=9558 |pages=283-92 |year=2007 |pmid=17258668 |doi=10.1016/S0140-6736(07)60150-0}}</ref><ref name="pmid15993230">{{cite journal |author=Rothwell PM, Giles MF, Flossmann E, ''et al'' |title=A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack |journal=Lancet |volume=366 |issue=9479 |pages=29-36 |year=2005 |pmid=15993230 |doi=10.1016/S0140-6736(05)66702-5}}</ref> | ===The ABCD<sup>2</sup> score=== | ||
The ABCD<sup>2</sup> score can predict likelihood of subsequent [[stroke]].<ref name="pmid17258668">{{cite journal |author=Johnston SC, Rothwell PM, Nguyen-Huynh MN, ''et al'' |title=Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack |journal=Lancet |volume=369 |issue=9558 |pages=283-92 |year=2007 |pmid=17258668 |doi=10.1016/S0140-6736(07)60150-0}}</ref><ref name="pmid15993230">{{cite journal |author=Rothwell PM, Giles MF, Flossmann E, ''et al'' |title=A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack |journal=Lancet |volume=366 |issue=9479 |pages=29-36 |year=2005 |pmid=15993230 |doi=10.1016/S0140-6736(05)66702-5}}</ref><ref name="pmid27721312">{{cite journal| author=Cutting S, Regan E, Lee VH, Prabhakaran S| title=High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack. | journal=Cerebrovasc Dis Extra | year= 2016 | volume= 6 | issue= 3 | pages= 76-83 | pmid=27721312 | doi=10.1159/000450692 | pmc=5091225 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27721312 }} </ref> | |||
The score is calculated as: | The score is calculated as:<br> | ||
'''Age''' | '''Age''' | ||
* ≥ 60 years = 1 point | * ≥ 60 years = 1 point | ||
* Blood pressure at presentation ≥ 140/90 mm Hg = 1 point | * Blood pressure at presentation ≥ 140/90 mm Hg = 1 point | ||
''' Clinical features''' | ''' Clinical features''' | ||
*Unilateral weakness = 2 points | |||
*Speech disturbance without weakness = 1 point | |||
''' Duration of attack''' | ''' Duration of attack''' | ||
* ≥ 60 minutes = 2 points | |||
* 10–59 minutes = 1 point | |||
* Diabetes = 1 point | * Diabetes = 1 point | ||
Interpretation of score, the risk for stroke: | Interpretation of score, the risk for stroke:<br> | ||
''' Score 0-3 (low)''' | ''' Score 0-3 (low)''' | ||
* 2 day risk = 1.0% | |||
* 7 day risk = 1.2% | |||
''' Score 4-5 (moderate)''' | ''' Score 4-5 (moderate)''' | ||
* 2 day risk = 4.1% | |||
* 7 day risk = 5.9% | |||
'''Score 6–7 (high)''' | '''Score 6–7 (high)''' | ||
* 2 day risk = 8.1% | |||
* 7 day risk = 11.7% | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
Latest revision as of 00:29, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
If left untreated, the symptoms of transient ischemic attack may subside with in few hours. However, there is increased risk of stroke in these patients in future. The risk is highest in the next within hours and subsequently decreases after days, weeks to months.[1]The prognosis of TIA depends on the possibilty of developing ischemic stroke in the future. There is 11 percent increased risk of ischemic stroke in patients having TIA for next seven days and 25-29% in next five years.[2] This is especially true in patients with TIA due to small-vessel disease (SVD) etiology with motor weakness (capsular warning syndrome).[2]
Natural History
If left untreated, the symptoms of transient ischemic attack may subside with in few hours. However, there is increased risk of stroke in these patients in future. The risk is highest in the next within hours and subsequently decreases after days, weeks to months.[1]
Complications
Complications of TIA include:[3][4][5][6][7]
- Ischemic stroke
- Hemorrhagic stroke
- Dementia
- Recurrent TIA
- Anxiety
Prognosis
The prognosis of TIA depends on the possibilty of developing ischemic stroke in the future. There is 11 percent increased risk of ischemic stroke in patients having TIA for next seven days and 25-29% in next five years.[2] This is especially true in patients with TIA due to small-vessel disease (SVD) etiology with motor weakness (capsular warning syndrome).[2]
The ABCD2 score
The ABCD2 score can predict likelihood of subsequent stroke.[8][9][10]
The score is calculated as:
Age
- ≥ 60 years = 1 point
- Blood pressure at presentation ≥ 140/90 mm Hg = 1 point
Clinical features
- Unilateral weakness = 2 points
- Speech disturbance without weakness = 1 point
Duration of attack
- ≥ 60 minutes = 2 points
- 10–59 minutes = 1 point
- Diabetes = 1 point
Interpretation of score, the risk for stroke:
Score 0-3 (low)
- 2 day risk = 1.0%
- 7 day risk = 1.2%
Score 4-5 (moderate)
- 2 day risk = 4.1%
- 7 day risk = 5.9%
Score 6–7 (high)
- 2 day risk = 8.1%
- 7 day risk = 11.7%
References
- ↑ 1.0 1.1 Sorensen AG, Ay H (2011). "Transient ischemic attack: definition, diagnosis, and risk stratification". Neuroimaging Clin N Am. 21 (2): 303–13, x. doi:10.1016/j.nic.2011.01.013. PMC 3109304. PMID 21640301.
- ↑ 2.0 2.1 2.2 2.3 Paul NL, Simoni M, Chandratheva A, Rothwell PM (2012). "Population-based study of capsular warning syndrome and prognosis after early recurrent TIA". Neurology. 79 (13): 1356–62. doi:10.1212/WNL.0b013e31826c1af8. PMC 3448742. PMID 22972645.
- ↑ Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P; et al. (2016). "One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke". N Engl J Med. 374 (16): 1533–42. doi:10.1056/NEJMoa1412981. PMID 27096581 : 27096581 Check
|pmid=value (help). - ↑ Schuknecht HF (1987). "Temporal bone collections in Europe and the United States. Observations on a productive laboratory, pathologic findings of clinical relevance, and recommendations". Ann Otol Rhinol Laryngol Suppl. 130: 1–19. PMID 3109304.
- ↑ Jacquin A, Aboa-Eboulé C, Rouaud O, Osseby GV, Binquet C, Durier J; et al. (2012). "Prior transient ischemic attack and dementia after subsequent ischemic stroke". Alzheimer Dis Assoc Disord. 26 (4): 307–13. doi:10.1097/WAD.0b013e3182420b2c. PMID 22193354.
- ↑ Broomfield NM, Quinn TJ, Abdul-Rahim AH, Walters MR, Evans JJ (2014). "Depression and anxiety symptoms post-stroke/TIA: prevalence and associations in cross-sectional data from a regional stroke registry". BMC Neurol. 14: 198. doi:10.1186/s12883-014-0198-8. PMC 4189556. PMID 25269762.
- ↑ Coutts SB, Hill MD, Campos CR, Choi YB, Subramaniam S, Kosior JC; et al. (2008). "Recurrent events in transient ischemic attack and minor stroke: what events are happening and to which patients?". Stroke. 39 (9): 2461–6. doi:10.1161/STROKEAHA.107.513234. PMID 18617658.
- ↑ Johnston SC, Rothwell PM, Nguyen-Huynh MN; et al. (2007). "Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack". Lancet. 369 (9558): 283–92. doi:10.1016/S0140-6736(07)60150-0. PMID 17258668.
- ↑ Rothwell PM, Giles MF, Flossmann E; et al. (2005). "A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack". Lancet. 366 (9479): 29–36. doi:10.1016/S0140-6736(05)66702-5. PMID 15993230.
- ↑ Cutting S, Regan E, Lee VH, Prabhakaran S (2016). "High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack". Cerebrovasc Dis Extra. 6 (3): 76–83. doi:10.1159/000450692. PMC 5091225. PMID 27721312.