Transient Ischemic Attack and Minor Stroke Management


Authors: M. Škorňa 1,2;  J. Neumann 3;  S. Peška 1;  R. Mikulík 2,4
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 2;  Iktové centrum, Neurologické oddělení, Krajská zdravotní a. s., Nemocnice Chomutov 3;  I. neurologická klinika LF MU a FN u sv. Anny v Brně 4
Published in: Cesk Slov Neurol N 2016; 79/112(2): 178-187
Category: Review Article
doi: 10.14735/amcsnn2016178

Overview

Transient ischemic attack (TIA) and minor stroke are acute cerebrovascular diseases that are usually non-disabling. However, if not followed adequately, they may lead to potentially fatal stroke recurrence. The aim of this review is to summarize the main challenges of the current clinical practice (in the Czech Republic) and suggest a rational algorithm for TIA/minor stroke management. This review informs about the new TIA definition based on the fact that up to 50% of TIA patients have a brain infarction on MRI (magnetic resonance imaging), about risk stratification and its use in patients management, about the importance of imaging studies and about the available treatment options. Risk stratification for TIA is underused in the Czech Republic and this affects risk-benefit ratios for the available management plans. In particular, follow-up of high-risk patients need urgent attention - patients with speech and/or motor symptoms lasting ≥ 5 min, with ABCD2 score ≥ 4, with atrial fibrillation, and patients with an infarction on DWI MRI or CT (computed tomography), and with an occlusion or significant ≥ 50% stenosis of a precerebral/cerebral large vessel. The review highlights the importance of an immediate medical intervention with early endarterectomy and provides an overview of new therapeutic options, e.g. dual antiplatelet therapy, the benefit of which has recently been documented for the first time.

Key words:
transient ischemic attack – minor stroke – risk stratification

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


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