Transient Ischaemic Attacks

Author: Katherine Henderson / Editors: Clifford J Mann, Lou Mitchell / Reviewer: Thomas Mac Mahon, Mehdi Teeli / Codes: / Published: 21/01/2022

Description:

Transient Ischaemic Attacks

After completing this session you will be able to:

  • Describe the epidemiology of TIA
  • Outline an appropriate strategy of investigation
  • List and differentiate possible mimics of TIA
  • Stratify the risk of stroke in TIA patients
  • Explain the treatment options with respect to stroke risk

References:

  1. Royal College of Physicians, National clinical guideline for stroke. Prepared by the Intercollegiate Stroke Working Party. 2016, Royal College of Physicians: London.
  2. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007 Dec;6(12):1063-72.
  3. Rothwell PM, Giles MF, Chandratheva A, Marquardt L, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007 Oct 20;370(9596):1432-42.
  4. Amarenco, P., et al., One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. N Engl J Med, 2016. 374(16): p. 1533-42.
  5. Royal College of Physicians Care Quality Improvement Department (CQID) on behalf of the Intercollegiate Stroke Working Party, Sentinel Stroke National Audit Programme (SSNAP). Acute organisational audit report. National Report England, Wales and Northern Ireland. November 2016. 2016, Royal College of Physicians: London.
  6. Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, Sherman DG; TIA Working Group. Transient ischemic attack–proposal for a new definition. N Engl J Med. 2002 Nov 21;347(21):1713-6.
  7. Ay H, Oliveira-Filho J, Buonanno FS, Schaefer PW, et al. ‘Footprints’ of transient ischemic attacks: a diffusion-weighted MRI study. Cerebrovasc Dis. 2002;14(3-4):177-86.
  8. Crisostomo RA, Garcia MM, Tong DC. Detection of diffusion-weighted MRI abnormalities in patients with transient ischemic attack: correlation with clinical characteristics. Stroke. 2003 Apr;34(4):932-7.
  9. Lovett JK, Coull AJ, Rothwell PM. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology. 2004 Feb 24;62(4):569-73.
  10. Nor AM, Davis J, Sen B, Shipsey D, et al. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005 Nov;4(11):727-34.
  11. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27;369(9558):283-92.
  12. Perry JJ, Sharma M, Sivilotti ML, Sutherland J, et al., Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ. 2011 Jul 12;183(10):1137-45.
  13. North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, et al., Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991 Aug 15;325(7):445-53.
  14. Lee WW, Jensen ER. Bilateral internal carotid artery dissection due to trivial trauma. J Emerg Med. 2000 Jul;19(1):35-41.
  15. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline [NG128]. 2019.
  16. Sacco RL. Risk factors for TIA and TIA as a risk factor for stroke. Neurology. 2004 Apr 27;62(8 Suppl 6):S7-11.
  17. Woo D, Gebel J, Miller R, et al. Incidence rates of first-ever ischemic stroke subtypes among blacks: a population-based study. Stroke. 1999 Dec;30(12):2517-22.
  18. Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis. JAMA. 2003 Feb 5;289(5):579-88.
  19. Perry J, Sivilotti, MLA, Emond M, et al. Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study. BMJ 2021;372:n49.

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