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risk factors for ischemic stroke after TIA

Notes: 1) TIA > 30 minutes in duration 2) disturbance in higher brain function as part of presentation (i.e. aphasia) 3) diffusion-weighted magnetic resonance imaging abnormalities [5] 4) a 7 point* ABCD2 score predicts short-term risk of stroke after TIA [2] - age > 60 (1) - blood pressure on presentation - systolic > 140 or diastolic > 90 mm Hg (1) - clinical features - unilateral weakness (2) - speech disturbance without weakness (1) - duration of symptoms - > 60 minutes (2) - 10-59 minutes (1) - < 10 minutes (0) - diabetes mellitus (1) * points in parentheses 5) multiple infarctions on brain imaging, large-artery atherosclerosis, & an ABCD2 score of 6 or 7 each associated with > 2-fold increase risk of stroke [6] - this in context of urgent care & management by stroke specialists that half risk of ischemic stroke [6] 6) risk of CV event including stroke after TIA = 6.4% in 1st year & 6.4% in 2nd-5th years [7]

General

risk factors for & prevention of ischemic stroke

References

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  2. Journal Watch 25(17):134, 2005 Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet. 2005 Jul 2-8;366(9479):29-36. PMID: 15993230 - Perry JJ et al. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ 2011 Jul 12; 183:1137. PMID: 21646462
  3. Tsivgoulis G et al, Validation of ABCD score in identifying individuals at high early risk of stroke after a transient ischemic attack: A hospital-based case series study. Stroke 2006, 37:2982 PMID: 17053179
  4. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27;369(9558):283-92. PMID: 17258668
  5. Giles MF et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: A multicenter study. Neurology 2011 Sep 27; 77:1222. PMID: 21865578
  6. Amarenco P, Lavallee PC, Labreuche J et al One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. N Engl J Med 2016; 374:1533-1542. April 21, 2016 PMID: 27096581 - Sacco RL, Rundek T The Value of Urgent Specialized Care for TIA and Minor Stroke. N Engl J Med. 2016 Apr 21;374(16):1577-1579. PMID: 27096584
  7. Amarenco P, Lavallee PC, Tavares LM et al Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke. N Engl J Med 2018; 378:2182-2190. June 7, 2018 PMID: 29766771 Free full text https://www.nejm.org/doi/full/10.1056/NEJMoa1802712