Management of transient ischemia attacks in the twenty-first century.
Patients who have a transient ischemic attack (TIA) represent a group that may appear well but are at high risk for stroke within 90 days. Management of patients who have a TIA requires an understanding of the short-term risk for stroke to guide acute management and the long-term benefits to medical and surgical therapies. The initial emergency department (ED) evaluation may be supplemented with simple TIA stroke risk scores to estimate short-term stroke risk. The addition of MRI provides yet more information regarding stroke risks, while identifying some specific causes of TIA. Extended testing may not be feasible in the ED, and to address this limitation, new outpatient strategies for patients who have a TIA have been developed, such as the use of an ED observation unit or an outpatient TIA clinic. Although controversy remains in some areas of acute TIA management because of the lack of evidence from controlled trials, evidence from large randomized trials have led to a better understanding of effective measures for the long-term prevention of stroke.
Ross
Michael
M
Department of Emergency Medicine, Emory University, Atlanta, Georgia 30322, USA. maross@emory.edu
Nahab
Fadi
F
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000628:therapy; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy; D003952:Diagnostic Imaging; D004636:Emergency Service, Hospital; D016894:Endarterectomy, Carotid; D004697:Endocarditis, Bacterial / Q000150:complications / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control; D015912:Thrombolytic Therapy; D020217:Vertebral Artery Dissection / Q000150:complications / Q000628:therapy
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors