Top Things to Know: Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting
Published: January 19, 2023
Prepared by Anne Leonard MPH, RN, FAHA – Senior Science and Medicine Advisor - Lead
- Transient ischemic attack has been recognized as a risk factor for a future stroke since the 1950’s.
- About 240,000 people in the United States experience a transient ischemic attack (TIA) every year. In addition, the 90-day stroke risk following a TIA is upwards of 17.8%, but with almost half of these occurring within 2 days of the index TIA.
- Because the symptoms are transitory, the diagnosis of TIA can be challenging whether made in an urban or in a rural setting.
- TIA symptoms can mimic other neurological symptoms. This scientific statement discusses what is considered a “stroke mimic” and differentiates what are considered true TIA symptoms versus those that may be a “TIA mimic”.
- Diagnostic evaluation includes the more sensitive magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) as preferred over non-contrast computed tomography (NCCT) to note brain tissue changes. However, NCCT with computed tomographic angiography (CTA) can be performed together to rule out intracranial hemorrhage or symptomatic intracranial stenosis.
- Use of extended cardiac monitoring in certain patients, such as patients with atrial fibrillation noted on ECG, can be helpful in evaluating for potential sources of cardiac embolism.
- Early neurology consultation, preferably in the emergency department (ED) or rapid follow-up within one week is optimal for patient care.
- TIA risk stratification scales help in the identification of high-risk patients. In addition, the use of a comprehensive neurological evaluation as well as intracerebral blood vessel imaging aid in patient disposition in the ED.
- This statement describes a secondary prevention checklist for patients suspected of having a TIA. This includes recommendations from the 2021 Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. This is also of high importance in underserved and rural communities. Telestroke, in this setting can provide this connection with these communities.
- TIA is a strong predictor for stroke and thus requires careful evaluation to identify high-risk patients. Several tools are available to health care professionals in the ED or rural setting to aid in that evaluation.
Citation
Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC; Ashcraft S, Burrus TM, Panagos PD, Wintermark M, Esenwa C; on behalf of the American Heart Association Emergency Neurovascular Care Committee of the Stroke Council and Council on Peripheral Vascular Disease. Diagnosis, workup, risk reduction of transient ischemic attack in the emergency department setting: a scientific statement from the American Heart Association [published online ahead of print January 19, 2023]. Stroke. doi: 10.1161/STR.0000000000000418