Abstract
Objectives
The aim was to investigate triage methods for suspected transient ischemic attacks
(TIAs) with focal or nonfocal symptoms.
Materials and methods
In total, 350 patients with suspected TIAs were enrolled and followed for one year.
Potential high-risk factors for TIAs, such as atrial fibrillation, carotid artery
stenosis, crescendo TIA, and ABCD2 score ≥ 4, were evaluated. Patients were classified
into 3 groups according to the initial neurological symptoms: focal, nonfocal, and
mixed (both focal and nonfocal) groups. Stroke-free survival rates were compared via
Kaplan-Meier analysis.
Results
Diffusion-weighted MRI (DWI) was performed for 89.8% of the patients within 7 days,
and the frequency of acute brain infarction on DWI was significantly lower in the
nonfocal group (focal, 24.1%; nonfocal, 7.2%; mixed, 22.2%; P < .01). There was no significant difference in the one-year event-free survival rates
across the groups.
Significantly higher stroke risk was observed in patients with one or more high-risk
categories or the ABCD2 score (≥ 4) in the focal group (P = .021 and .26, respectively), whereas no significant difference was observed in
the other groups. Across all symptom groups, significantly higher stroke risk was
observed in patients showing acute infarcts on DWI evaluated within 7 days.
Conclusions
Both high-risk categorization (≥ 1 potential high-risk factors) and ABCD2 score (≥ 4)
alone were useful tools for identifying higher stroke risk in patients with focal
symptom but not with nonfocal symptoms in isolation. Further studies are warranted
in triage methods for TIA with nonfocal in isolation in conjunction with DWI.
Key Words
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References
- Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III.Stroke. 1990; 21: 637-676
- Definition and evaluation of transient ischemic attack. A scientific statement for healthcare professionals from the American heart association/American stroke association stroke council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease.Stroke. 2009; 40: 2276-2293
OECD (2020), Magnetic resonance imaging (MRI) units (indicator). doi: 10.1787/1a72e7d1-en (Accessed on 4 November 2020)
- Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related sustainable development goals for 195 countries and territories: a systematic analysis for the global burden of disease study 2017.Lancet. 2018; 392: 2091-2138
- Implementation of a community-based triage for patients with suspected transient ischemic attack or minor stroke study: a prospective multicenter observational study.J Stroke Cerebrovasc Dis. 2016; 25: 745-751
- Acute ischemic cerebrovascular syndrome: diagnosis criteria.Stroke. 2003; 34: 2995-2998
- Transient neurological attacks in the general population: prevalence, risk factors, and clinical relevance.Stroke. 1997; 28: 768-773
- Incidence and prognosis of transient neurological attacks.JAMA. 2007; 298: 2877-2885
- Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack.Lancet. 2007; 369: 283-292
- Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study.Neurology. 2011; 77: 1222-1228
- Significance of nonfocal symptoms in patients with transient ischemic attack.Stroke. 2018; 49: 1893-1898
- One-year prognosis of transient ischemic attacks with nonfocal symptoms.Clin Neurol Neurosurg. 2020; 196105977https://doi.org/10.1016/j.clineuro.2020.105977
- Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns.Neurology. 2006; 67: 1178-1183
- Oxford vascular study: transient isolated brainstem symptoms preceding posterior circulation stroke: a population-based study.Lancet Neurol. 2013; 12: 65-71
- Transient neurological attack before vertebrobasilar stroke.J Neurol Sci. 2013; 15: 39-42
- Vestibular symptoms in acute hemispheric strokes.J Neurol. 2019; 266: 1852-1858
- Transient ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome.Cerebrovasc Dis. 2011; 32: 57-64
- Clinical policy: critical issues in the evaluation of adult patients with suspected transient ischemic attack in the emergency department.Ann Emerg Med. 2016; 68: 354-370
- Stroke and Transient Ischaemic Attack in over 16s: Diagnosis and Initial Management.NICE, London2019 (GuidelineNo. 128May) (Accessed Nov 4, 2020)
- Frequent inaccuracies in ABCD2 scoring in non-stroke specialists' referrals to a daily rapid access stroke prevention service.J Neurol Sci. 2013; 15: 30-34
- The ABCD2 score is better for stroke risk prediction after anterior circulation TIA compared to posterior circulation TIA.Int J Neurosci. 2015; 125: 50-55
Article info
Publication history
Published online: November 23, 2021
Accepted:
October 17,
2021
Received in revised form:
September 22,
2021
Received:
March 12,
2021
Footnotes
Grant support: This study was supported by the Kanagawa Neurosurgeon and Neurologist Association, the Kanagawa branch of the Japan Stroke Association, and the Department of Neurology, St Marianna University.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106185
Copyright
© 2021 Elsevier Inc. All rights reserved.
