[Transient ischemic attacks and prolonged reversible ischemic neurologic deficit. Diagnosis, differential diagnosis and treatment].
Cerebral and ocular ischemic events are classified according to their duration and localisation in transient (< 24 hours) or permanent (> or = 24 hours) cerebral (transient ischemic attack (TIA), cerebral infarct) and ocular (amaurosis fugax, retinal infarct) deficits. The terms "Prolonged Reversible Ischemic Neurological Deficit" (PRIND, > or = 24 hours to < or = 7 days) and "Reversible Ischemic Neurological Deficit" (RIND, > or = 24 hours to < or = 3 days) are no longer used. The differential diagnosis of TIAs and ischemic strokes is discussed. Ischemic strokes are an emergency and should be referred within five hours at the latest to a centre, which offers around the clock acute therapies such as fibrinolysis and an organised stroke management. Secondary stroke prevention after TIA or stroke encompasses the treatment of vascular risk factors, carotid endarterectomy, anticoagulation in the presence of cardiac embolism (target international normalised ratio, 2.5; range 2.0-3.0) and the administration of platelet inhibitors. Carotid endarterectomy is indicated, when luminal narrowing is at least 70%, and not indicated when it is less than 50%. The benefit of endarterectomy in 50-69% stenoses decreases, and individual predictors of the operation risk are useful for choosing the appropriate treatment. Patients without indication for carotid endarterectomy or oral anticoagulation are treated with platelet inhibitors. We use the combination dipyridamole-aspirin as first choice drug, because it has been shown to be superior to aspirin and dipyridamole alone. In the presence of adverse effects or contraindications for dipyridamole we prescribe aspirin (100-300 mg daily). We administer clopidogrel (75 mg daily) if dipyridamole and aspirin are not indicated, have caused adverse effects, or did not prevent ocular or cerebral ischemic events.
Mosso
M
M
Neurologische Klinik, UniversitätsSpital, Zürich.
Baumgartner
R W
RW
D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D002545:Brain Ischemia / Q000175:diagnosis* / Q000628:therapy; D002544:Cerebral Infarction / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D004176:Dipyridamole / Q000008:administration & dosage / Q000009:adverse effects; D016894:Endarterectomy, Carotid; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy; D009460:Neurologic Examination
D004176:Dipyridamole; D001241:Aspirin