Initial evaluation and management of transient ischemic attack and minor ischemic stroke
- Karen L Furie, MD, MPH
Karen L Furie, MD, MPH
- Chair and Professor of Neurology
- Alpert Medical School of Brown University
- Hakan Ay, MD
Hakan Ay, MD
- Stroke Service, Department of Neurology
- A.A. Martinos Center for Biomedical Imaging, Department of Radiology
- Massachusetts General Hospital
- Harvard Medical School
Patients with transient ischemic attack (TIA) or minor (ie, nondisabling) stroke are at increased risk of recurrent stroke, and therefore require urgent evaluation and treatment since immediate intervention may substantially reduce the risk of recurrent stroke.
This topic will review the diagnostic approach and early management of TIA and minor, nondisabling ischemic stroke.
Other aspects of transient cerebral ischemia are discussed separately. (See "Definition of transient ischemic attack" and "Etiology and clinical manifestations of transient ischemic attack" and "Differential diagnosis of transient ischemic attack and stroke".)
The management of patients hospitalized with acute stroke is reviewed elsewhere. (See "Initial assessment and management of acute stroke".)
How is TIA defined? — Transient ischemic attack (TIA) is now defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction [1,2]. The end point, stroke, is biologic (tissue injury) rather than arbitrary (≥24 hours). In keeping with this definition of TIA, ischemic stroke is defined as an infarction of central nervous system tissue.
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- How is TIA defined?
- How is minor stroke defined?
- URGENT EVALUATION
- Hospital or outpatient evaluation?
- Brain imaging studies
- Neurovascular evaluation
- Cardiac evaluation
- Blood tests
- RISK OF RECURRENT STROKE
- TIA etiology
- Risk stratification
- - Importance of infarction
- IMMEDIATE TREATMENT
- Treatment by etiology
- Risk factor management
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS