Transient ischemic attack: Difference between revisions

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__NOTOC__
'''For patient information, click [[Transient ischemic attack (patient information)|here]]'''
'''For patient information, click [[Transient ischemic attack (patient information)|here]]'''
{{Infobox_Disease
| Name          = Transient ischemic attack
| Image          =
| Caption        =
| DiseasesDB    = 13253
| ICD10          = {{ICD10|G|45|9|g|40}}
| ICD9          = {{ICD9|435.9}}
| ICDO          =
| OMIM          =
| MedlinePlus    = 000730
| eMedicineSubj  =
| eMedicineTopic =
| MeshID        = D002546
}}
{{SI}}
{{CMG}}


==Overview==
{{Transient ischemic attack}}
A '''transient ischemic attack''' ('''TIA''', often colloquially referred to as "'''mini stroke'''") is caused by the temporary disturbance of blood supply to a restricted area of the [[brain]], resulting in brief neurologic dysfunction that usually persists for less than 24 hours.
{{CMG}}{{AE}}{{AAA}}


== Symptoms ==
{{SK}} TIA; mini stroke
Symptoms vary widely from person to person depending on the area of the brain involved. The most frequent symptoms include temporary loss of vision (typically ''[[amaurosis|amaurosis fugax]]''), difficulty speaking ([[dysarthria]]), weakness on one side of the body ([[hemiparesis]]), numbness usually on one side of the body, and loss of consciousness. If there are neurological symptoms persisting for more than 24 hours, it is classified as a [[cerebrovascular accident]] (stroke).
==[[Transient ischemic attack overview|Overview]]==


== Prognosis ==
==[[Transient ischemic attack historical perspective|Historical Perspective]]==
Patients diagnosed with a TIA are sometimes said to have had a warning for an approaching cerebrovascular accident. If the time period of blood supply impairment lasts more than a few minutes, the nerve cells of that area of the brain die and cause permanent neurologic deficit. One third of the people with TIA later have recurrent TIAs and one third have a [[stroke]] due to permanent nerve cell loss.


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>
==[[Transient ischemic attack pathophysiology|Pathophysiology]]==


The score is calculated as:
==[[Transient ischemic attack causes|Causes]]==
* 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:
==[[Transient ischemic attack differential diagnosis|Differentiating Transient Ischemic Attack from other Diseases]]==
* 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%


==Causes==
==[[Transient ischemic attack epidemiology and demographics|Epidemiology and Demographics]]==
The most common cause of a TIA is an [[embolus]] (a small blood clot) that occludes an artery in the brain. This most frequently arises from an [[Atheroma|atherosclerotic plaque]] in one of the [[carotid artery|carotid arteries]] (i.e. a number of major arteries in the head and neck) or from a [[thrombus]] (i.e. a blood clot) in the heart due to [[atrial fibrillation]].


Other reasons include excessive narrowing of large vessels due to an atherosclerotic plaque and increased blood viscosity due to some [[blood diseases]]. TIA is related with other medical conditions like [[hypertension]], [[heart disease]] (especially [[atrial fibrillation]]), [[migraine]], [[cigarette smoking]], [[hypercholesterolemia]], and [[diabetes mellitus]].
==[[Transient ischemic attack risk factors|Risk Factors]]==


== Prevention ==
==[[Transient ischemic attack natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


=== Primary prevention ===
==Diagnosis==
The use of anti-coagulant medications, heparin and warfarin; or anti-platelet medications such as aspirin
[[Transient ischemic attack history and symptoms|History and Symptoms]] | [[Transient ischemic attack physical examination|Physical Examination]] | [[Transient ischemic attack laboratory findings|Laboratory Findings]] | [[Transient ischemic attack electrocardiogram|Electrocardiogram]] | [[Transient ischemic attack CT|CT]] | [[Transient ischemic attack MRI|MRI]] |  [[Transient ischemic attack echocardiography|Echocardiography]] | [[Transient ischemic attack ultrasound|Ultrasound]] | [[Transient ischemic attack other imaging findings|Other Imaging Findings]] | [[Transient ischemic attack other diagnostic studies|Other Diagnostic Studies]]
 
=== Secondary prevention ===
 
=== Tertiary prevention ===


==Treatment==
==Treatment==
The mainstay of treatment following acute recovery from a TIA should be to diagnose and treat the underlying cause.  It is not always immediately possible to tell the difference between a CVA (stroke) and a TIA.  Most patients who are diagnosed at a hospital's [[Emergency department|Accident & Emergency Department]] as having suffered from a TIA will be discharged home and advised to contact their primary physician to organize further investigations.
[[Transient ischemic attack medical therapy|Medical Therapy]] | [[Transient ischemic attack surgery|Surgery]] | [[Transient ischemic attack primary prevention|Primary Prevention]] | [[Transient ischemic attack secondary prevention|Secondary Prevention]] | [[Transient ischemic attack cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Transient ischemic attack future or investigational therapies|Future or Investigational Therapies]]
 
The initial treatment is Aspirin, second line is clopidogrel, third line is ticlopidine.  If TIA is recurrent after Aspirin treatment, the combination of Aspirin and dipirydamole is needed (Aggrenox).
 
An [[electrocardiogram]] (ECG) may show atrial fibrillation, a common cause of TIAs, or other arrhythmias that may cause embolisation to the brain. An [[echocardiogram]] is useful in detecting thrombus within the heart chambers. Such patients benefit from [[anticoagulation]].
 
If the TIA affects an area supplied by the carotid artery, an [[ultrasound]] ([[Transcranial doppler|TCD]]) scan may demonstrate carotid [[stenosis]]. For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a [[carotid endarterectomy]], may be recommended.
 
Some patients may also be given modified release [[dipyridamole]] or [[clopidogrel]].
 
==References==
<references/>


==External links==
== Case Studies ==
* [http://www.nlm.nih.gov/medlineplus/transientischemicattack.html Transient Ischemic Attack] at MedlinePlus
[[Transient ischemic attack case study one|Case #1]]


{{CNS diseases of the nervous system}}
{{CNS diseases of the nervous system}}
{{Electrocardiography}}
{{Electrocardiography}}
{{Circulatory system pathology}}
{{Circulatory system pathology}}
{{SIB}}
 


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Latest revision as of 03:21, 18 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

Synonyms and keywords: TIA; mini stroke

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Transient Ischemic Attack from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | CT | MRI | Echocardiography | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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