University of Oklahoma Health Sciences Center

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Author/s:

Perry, J. J., Yadav, K., Syed, S., Shamy, M.

Date Added:

January 28, 2023

Journal/Publication:

CMAJ

Publisher:

CMA Impact

Publication Date:

October 11, 2022

Issue:

Volume:

194

Pages:

E1344-E1349

URL:

Transient ischemic attack and minor stroke: diagnosis, risk stratification and management

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.220344

PMID (1):

36220167

Keywords

atrial fibrillation

Brain Ischemia

Cerebral Infarction

Migraine Disorders

electrocardiography

MeSH

ischemic attack, transient

Hydroxymethylglutaryl-CoA Reductase Inhibitors

antihypertensive agents

Platelet Aggregation Inhibitors

anticoagulants

RPR Commentary

Evidence-based guidance for evaluation and management of patients with suspected transient ischemic attack. James W. Mold, MD, MPH

Abstract

Patients with suspected cerebral ischemia should be urgently assessed to distinguish between transient ischemic attack (TIA), minor stroke or mimics such as migraine, seizure, vertigo or syncope.

The Canadian TIA Score can be used to determine risk for early subsequent stroke in patients with a suspected TIA or minor stroke.

All patients with TIA or minor stroke should undergo urgent electrocardiography and computed tomography of the head.

Clinicians should order early vascular imaging for patients at moderate or high risk of subsequent stroke; urgent revascularization should be considered if there is more than 50% arterial stenosis congruent with symptom presentation.

Clinicians should prescribe dual antiplatelet drugs for high-risk patients, single antiplatelet agents for low-risk patients or direct oral anticoagulants for patients with atrial fibrillation.

All patients with TIA or minor stroke should be counselled about modifiable lifestyle factors (including smoking cessation), be treated with statins and take steps toward optimizing blood pressure, including treatment with antihypertensive drugs, if necessary.

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