Emergent cerebrovascular disease risk factor weighting: is transient ischemic attack an imminent threat?
Transient ischemic attack (TIA) is a neglected condition and a marker of atherothrombotic disease. Several cohort studies have demonstrated that the risk of early cerebral infarct after TIA is much higher than previously thought. Many studies have shown that the risk of stroke is high after TIA, and is on average 4-6% in the first 2 days. Up to 23% of strokes are preceded by transient ischemic attack (TIA), and there is substantial research interest in improving prevention during the short window between TIA and stroke. Nonetheless, patients with TIA are often managed without urgency. The currently available evidence suggests that the application of clinical scales is useful for the detection of patients with high risk of recurrence, and this is increased significantly when the information from neuroimaging and Doppler assessments is added. However, the limited prognostic value of these clinical variables together with the elevated risk of suffering an adverse vascular event are driving the search for new predictive factors (biological markers, neuroimaging data, ultrasound) that will help towards a better discrimination of high-risk patients. Recent studies have demonstrated that prompt evaluation and treatment of patients with TIA in a dedicated outpatient unit is associated with a lower than expected risk of subsequent stroke.
Gállego
Jaime
J
Stroke Unit, Service of Neurology, Hospital de Navarra, Navarra Health Service, Pamplona, Spain. jgallegoc@meditex.es
Muñoz
Roberto
R
Martínez-Vila
Eduardo
E