Transient ischemic attack natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Complications
Complications of TIA include:
- Ischemic stroke
- Hemorrhagic stroke
- Cognitive dysfunction
- Recuurent TIA
- Anxiety
Prognosis
Overall, about 10% of patients will have a stroke within 7 days.[1] This is especially true in patients with TIA due to small-vessel disease (SVD) etiology with motor weakness (capsular warning syndrome).[1]
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 ABCD2 score can predict likelihood of subsequent stroke.[2][3]
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 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.
- ↑ 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.