[Transient ischemic attack, a medical emergency].
Transient ischemic attack (TIA) is a medical emergency, which has been newly termed as "acute cerebrovascular syndrome" (ACVS). TIA is often ignored or unrecognized by patients or their families since its symptoms are naturally subsided without any treatment. TIA is also usually underestimated or nonprioritized by physicians because it is regarded merely as a minor stroke. However, stroke risk is very high in patients early after TIA. Therefore, rapid evaluation followed by immediate treatment is essential in TIA patients. TIA patients should be directly referred to stroke specialists in TIA clinics to consider hospitalization for specific emergent treatments. Early stroke risk is especially high in TIA patients with a high ABCD2 score of 4 or more (A age over 60 years [1 point]: B blood pressure > 140/90 mmHg [1 point]: C Clinical features, including unilateral weakness [2 points] and speech disturbance without weakness [1 point] D2: Diabetes [1 point] and Duration of symptoms [1 point for < 60 min and 2 points for > 60 min]), acute ischemic lesions on diffusion weighted image, > 50% carotid stenosis, severe intracranial artery stenosis, microembolic signals on transcranial Doppler, atrial fibrillation, or hypercoagulable states. It has been reported that immediate starting treatment with statins, antiplatelet agents, and antihypertensives substantially reduces the risk of stroke within 90 days after TIA. US National Stroke Association guidelines recommend assessments using computed tomography (CT)/ CT angiography (CTA), magnetic resonance imaging (MRI)/MR angiography (MRA), and carotid ultrasonography as well as immediate starting antiplatelet therapy in patients with non-cardioembolic TIA or oral anticoagulant therapy in patients with cardioembolic TIA within 24 hours during the first week after TIA. A large international, multicenter cooperative, observational study (TIA Registry. Org.) on 5,000 patients with TIA or minor stroke within 7 days of onset is being initiated. Now, we should say "Time is TIA".
Uchiyama
Shinichiro
S
Department of Neurology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162 8666, Japan.
D000959:Antihypertensive Agents / Q000627:therapeutic use; D003952:Diagnostic Imaging; D004630:Emergencies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012306:Risk; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors