{ "schemaVersion": 2, "eyebrow": "Vascular Neurology", "title": "Transient Ischemic Attack Evaluation", "summary": "Treat suspected transient ischemic attack as a time-sensitive cerebrovascular emergency: establish whether infarction or a high-risk mechanism is present, complete brain, vascular, and cardiac evaluation promptly, initiate mechanism-appropriate prevention, and reserve discharge for patients with a completed expedited pathway.", "seoDescription": "Practical evaluation and disposition of suspected transient ischemic attack, including imaging, cardiac testing, risk assessment, admission decisions, and prevention.", "clinicalQuestion": "How should U.S. clinicians urgently evaluate, risk-stratify, treat, and determine disposition for suspected transient ischemic attack?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "transient ischemic attack", "TIA evaluation", "TIA disposition", "ABCD2", "diffusion-weighted MRI", "carotid stenosis", "secondary stroke prevention" ], "keyTakeaways": [ "A transient focal neurologic syndrome requires urgent stroke evaluation; visible infarction on neuroimaging reclassifies the event as ischemic stroke rather than TIA. [12]", "Obtain brain imaging with diffusion-weighted MRI when feasible and vascular imaging of the cervical circulation; restricted diffusion and carotid stenosis identify patients with higher recurrent ischemic risk. [9][10]", "Do not use a low ABCD2 score as a stand-alone discharge criterion: ischemic lesions and early strokes occur in clinically low-risk categories. [9][16]", "For noncardioembolic high-risk TIA or minor ischemic stroke, short-term aspirin-clopidogrel therapy begun within 24 hours and continued for 3 weeks reduces early stroke risk in selected patients. [4][5]", "Symptomatic carotid stenosis requires expedited revascularization assessment: carotid endarterectomy is recommended for severe 70% to 99% stenosis and is targeted within 2 weeks of the index event. [23]", "Disposition should be driven by completed urgent diagnostic capability and actionable findings, not symptom resolution alone; AHA/ASA guidance supports completing TIA/stroke workup within 48 hours. [23]" ], "sections": [ { "id": "treat-as-acute-stroke-pathway", "eyebrow": "Immediate decision", "heading": "Route suspected TIA through an acute cerebrovascular pathway", "intro": "Resolution of symptoms does not eliminate early stroke risk.", "paragraphs": [ "Activate an acute stroke/TIA evaluation pathway for a credible transient focal neurologic deficit, particularly unilateral weakness, aphasia, or transient monocular visual loss. The tissue-based definition does not impose a symptom-duration threshold: a brief ischemic episode without permanent infarction is TIA, whereas an imaging-visible infarct is ischemic stroke even if symptoms have resolved. [12]", "The early hazard is front-loaded: maximal post-TIA stroke risk occurs during the first 48 hours. Therefore, use the same urgent operational posture for a resolved focal deficit as for minor stroke until brain imaging, vascular imaging, electrocardiography, and a disposition plan establish otherwise. [9][23]", "Transient monocular visual loss and retinal arterial occlusion syndromes warrant the same urgent brain and vascular evaluation as cerebral ischemia. Ocular ischemic presentations are systemic and ocular emergencies rather than isolated ophthalmic complaints. [12]" ], "bullets": [ "If symptoms are ongoing, recurrent, or fluctuating, manage as an active acute stroke syndrome rather than an outpatient TIA problem.", "Document the focal syndrome precisely: reliable weakness qualifies for the ABCD2 motor component; nonspecific “heaviness” or “clumsiness” should not be coded as weakness. [9]", "Do not label an event “low risk” merely because symptoms lasted less than 1 hour; symptom duration does not exclude tissue-positive ischemia. [12]" ], "subsections": [], "table": { "caption": "Operational distinctions that change the initial pathway. [12][9]", "columns": [ "Finding", "Interpretation", "Immediate action" ], "rows": [ [ "Persistent or recurrent focal deficit", "Possible ongoing ischemic stroke", "Continue acute stroke evaluation and urgent reperfusion eligibility assessment." ], [ "Resolved focal deficit with acute DWI lesion", "Ischemic stroke, not tissue-defined TIA. [12]", "Admit or manage in a stroke-capable pathway; define mechanism and secondary prevention urgently." ], [ "Resolved focal deficit without infarction", "TIA remains possible; early stroke risk persists. [12][9]", "Complete urgent brain, vascular, and cardiac evaluation before discharge or through a tightly controlled expedited pathway." ], [ "Transient monocular visual loss", "Retinal/cerebral ischemic warning syndrome. [12]", "Obtain urgent brain MRI with DWI and vascular evaluation." ] ] } }, { "id": "diagnostic-workup", "eyebrow": "Diagnostic workup", "heading": "Complete brain, vascular, and cardiac testing on an urgent timeline", "intro": "Testing should identify infarction and a mechanism that changes prevention or disposition.", "paragraphs": [ "Obtain brain imaging promptly. Noncontrast CT can identify some acute findings, but MRI with diffusion-weighted imaging is substantially more sensitive for acute ischemia after transient symptoms. Restricted diffusion changes the diagnosis to ischemic stroke and is associated with greater short-term recurrent ischemic risk. [9][12]", "Image the cervical circulation during the index evaluation. Carotid stenosis is an actionable recurrent-stroke marker and is incorporated with acute DWI findings in imaging-enhanced risk scores. A symptomatic severe internal carotid stenosis of 70% to 99% should trigger urgent vascular surgery or stroke-service assessment for carotid endarterectomy; intervention is targeted within 2 weeks of the event. [10][23]", "Obtain an ECG during the acute evaluation and pursue a cardiac source evaluation when no clear large-artery cause is found. For cryptogenic stroke, both AHA/ASA and European guidance support consideration of long-term cardiac rhythm monitoring; this is particularly relevant when an embolic mechanism remains plausible after initial testing. [23]", "AHA/ASA guidance supports completing TIA/stroke workup within 48 hours of the index event. If the emergency department cannot reliably obtain MRI, vascular imaging, ECG, and rapid mechanism-directed follow-up within that window, observation or admission is the safer disposition framework. [23]" ], "bullets": [ "Brain MRI with DWI: use to detect acute infarction missed by CT and to identify a higher-risk tissue-positive event. [9]", "Carotid imaging: obtain urgently because symptomatic stenosis may require revascularization within 2 weeks. [23]", "ECG: obtain during the initial workup; extend rhythm monitoring when the cause remains cryptogenic. [23]", "Do not substitute a negative DWI result for etiologic evaluation; DWI-negative patients can still have clinically important vascular disease requiring prevention. [14]" ], "subsections": [ { "heading": "How imaging changes the next step", "paragraphs": [ "DWI-positive lesions and stenotic vascular lesions improve prediction beyond clinical scoring alone. ABCD3-I incorporates carotid stenosis and acute DWI abnormalities, and imaging-based assessment has outperformed ABCD2 for subsequent stroke prediction in definite TIA cohorts. [10]" ], "bullets": [ "Acute DWI lesion: classify as ischemic stroke and escalate the evaluation to define mechanism. [12]", "Symptomatic carotid stenosis: accelerate revascularization review rather than relying on medical follow-up alone. [23]", "No infarct and no high-risk vascular lesion: disposition still requires assured rapid completion of any unfinished cardiac or vascular evaluation. [23]" ] } ], "table": { "caption": "Urgent test set and disposition consequences. [9][10][12][23]", "columns": [ "Test", "Actionable result", "Disposition or treatment consequence" ], "rows": [ [ "Brain MRI with DWI", "Restricted diffusion indicates acute infarction. [9][12]", "Manage as ischemic stroke; complete mechanism-directed secondary prevention urgently." ], [ "Cervical vascular imaging", "Symptomatic 70% to 99% carotid stenosis. [23]", "Urgent carotid endarterectomy assessment; target revascularization within 2 weeks." ], [ "ECG", "Atrial fibrillation or another arrhythmia suggesting cardioembolism", "Shift prevention planning toward anticoagulation assessment rather than antiplatelet-only treatment. [23]" ], [ "Long-term cardiac monitoring", "Occult AF in cryptogenic stroke evaluation", "Consider when initial testing does not establish a cause. [23]" ] ] } }, { "id": "risk-stratification-and-disposition", "eyebrow": "Disposition", "heading": "Use risk scores as adjuncts, not as a discharge rule", "intro": "Imaging and mechanism determine risk more reliably than a clinical score alone.", "paragraphs": [ "Calculate ABCD2 only after documenting the syndrome accurately, but do not use the score as the sole determinant of emergency department discharge. In a validation cohort, four patients categorized as low risk had stroke within 7 days, comprising 5.9% of strokes in the low-risk category; imaging-positive events can also occur with low ABCD2 scores. [9][16]", "When available, incorporate recurrent events and imaging into risk assessment. ABCD3-I adds recent dual TIA, carotid stenosis, and acute DWI abnormalities; imaging-enhanced scores have shown better short- and long-term stroke prediction than ABCD2 in definite TIA populations. This supports a disposition approach centered on DWI findings, vascular lesions, and recurrent symptoms rather than an isolated clinical score. [10]", "Admit or place in an observation/stroke unit when the event is recurrent, MRI shows infarction, vascular imaging shows symptomatic stenosis, cardiac rhythm evaluation suggests a cardioembolic source, or the urgent workup cannot be completed and acted on promptly. Conversely, discharge is reasonable only when an alternative diagnosis or a low-risk ischemic evaluation is established and a rapid, reliable pathway can complete outstanding testing and prevention within the guideline-supported 48-hour window. [23]" ], "bullets": [ "Do not discharge solely for ABCD2 0 to 3; low-score patients can have early stroke and tissue-positive ischemia. [9][16]", "Escalate disposition for recurrent TIAs (“dual TIA”), carotid stenosis, or acute DWI abnormalities because each increases risk classification in ABCD3-I. [10]", "Use an observation pathway only if it can deliver MRI, vascular imaging, ECG, specialist interpretation, antithrombotic selection, and definite follow-up on the required timeline. [23]" ], "subsections": [], "table": { "caption": "Disposition framework for suspected TIA. [9][10][16][23]", "columns": [ "Disposition feature", "Why it matters", "Recommended operational response" ], "rows": [ [ "Acute infarct on DWI", "Tissue-positive ischemic stroke and higher short-term recurrent risk. [9][12]", "Stroke admission or equivalent stroke-capable management." ], [ "Symptomatic carotid stenosis", "Potentially time-sensitive revascularization target. [23]", "Urgent inpatient or expedited vascular surgery pathway." ], [ "Recurrent transient focal events", "Dual TIA is a component of ABCD3-I and signals increased risk. [10]", "Observation or admission to complete immediate etiologic workup." ], [ "Low ABCD2 without completed imaging", "Clinical score misses some early strokes and tissue-positive events. [9][16]", "Do not discharge on score alone; complete imaging-based evaluation." ], [ "Negative initial testing with assured rapid follow-up", "Further cardiac/vascular assessment may still be required. [23]", "Discharge only through a defined rapid-access stroke/TIA pathway." ] ] } }, { "id": "mechanism-directed-prevention", "eyebrow": "Immediate prevention", "heading": "Start secondary prevention once hemorrhage and major treatment conflicts are addressed", "intro": "Antithrombotic choice and revascularization planning depend on the presumed mechanism.", "paragraphs": [ "For selected patients with noncardioembolic high-risk TIA or minor ischemic stroke, begin dual antiplatelet therapy with aspirin plus clopidogrel within 24 hours of symptom onset and continue it for 3 weeks. This short-term approach reduces early stroke risk; prolonged aspirin-clopidogrel combination therapy is not recommended as a routine long-term secondary prevention strategy. [4][5][7][23]", "If atrial fibrillation is identified and no competing contraindication is present, secondary prevention should be anticoagulation-based; guideline comparisons support a direct oral anticoagulant for nonvalvular AF after ischemic stroke or TIA. Do not treat an established cardioembolic mechanism as a routine noncardioembolic dual-antiplatelet indication. [23]", "For symptomatic carotid disease, medical prevention does not replace urgent revascularization assessment when stenosis is severe. Carotid endarterectomy is recommended for symptomatic 70% to 99% stenosis, with revascularization targeted within 2 weeks; for 50% to 69% stenosis, AHA/ASA recommendations individualize endarterectomy according to factors including age and sex. [23]", "Address modifiable vascular risk factors during the index encounter. AHA/ASA secondary prevention strategies apply similarly after ischemic stroke and TIA; targets cited in guideline comparison include LDL cholesterol below 70 mg/dL for atherosclerotic stroke etiology, alongside blood pressure control, smoking cessation, diet, and physical activity interventions. [23][24]" ], "bullets": [ "Noncardioembolic high-risk TIA/minor stroke: aspirin plus clopidogrel for 3 weeks when initiated within 24 hours in appropriate patients. [4][5]", "Nonvalvular AF: assess for direct oral anticoagulant-based secondary prevention. [23]", "Severe symptomatic carotid stenosis: arrange carotid endarterectomy evaluation without delaying for routine outpatient follow-up. [23]", "Intracranial arterial disease: avoid angioplasty and stenting as routine secondary prevention. [23]" ], "subsections": [ { "heading": "Avoid mechanism-treatment mismatches", "paragraphs": [ "The critical fork is cardioembolic versus noncardioembolic disease. Identify AF or another cardiac source before defaulting to antiplatelet-only treatment, and identify symptomatic carotid stenosis before treating the patient as medically managed cryptogenic TIA. These findings alter both the prevention strategy and the urgency of disposition. [23]" ], "bullets": [ "Do not continue aspirin-clopidogrel indefinitely for routine secondary prevention after a noncardioembolic event. [7][23]", "Do not routinely use intracranial angioplasty or stenting for intracranial arterial disease. [23]", "Do not delay carotid endarterectomy assessment when symptomatic stenosis is 70% to 99%. [23]" ] } ], "table": { "caption": "Mechanism-directed prevention after TIA or minor ischemic stroke. [4][5][7][23][24]", "columns": [ "Mechanism or finding", "Immediate prevention decision", "Time-sensitive next step" ], "rows": [ [ "Noncardioembolic high-risk TIA or minor stroke", "Aspirin plus clopidogrel begun within 24 hours and continued for 3 weeks in selected patients. [4][5]", "Transition to long-term antiplatelet-based secondary prevention rather than routine prolonged dual therapy. [7][23]" ], [ "Nonvalvular AF", "Assess for direct oral anticoagulant-based secondary prevention. [23]", "Complete cardioembolic evaluation and anticoagulation decision." ], [ "Symptomatic carotid stenosis 70% to 99%", "Initiate medical prevention while pursuing revascularization. [23]", "Carotid endarterectomy assessment; target intervention within 2 weeks. [23]" ], [ "Atherosclerotic stroke etiology", "Intensive vascular risk-factor treatment. [23][24]", "Target LDL cholesterol below 70 mg/dL. [23]" ] ] } }, { "id": "safe-discharge-pathway", "eyebrow": "Implementation", "heading": "Make discharge conditional on a documented expedited pathway", "intro": "A discharge plan is an operational commitment, not a referral suggestion.", "paragraphs": [ "Before discharge, document the focal syndrome, time last known well, brain imaging result, vascular imaging result or scheduled completion time, ECG result, antithrombotic decision, and the responsible clinician or service for follow-up. The key standard is completion of the TIA/stroke workup within 48 hours under AHA/ASA guidance, with more urgent action when MRI or vascular studies disclose high-risk findings. [23]", "A patient discharged after a negative initial assessment should receive explicit return precautions for recurrent focal deficits and must have a pathway that can act on delayed test results, especially carotid stenosis or occult AF. Symptom resolution is not an adequate endpoint because early recurrence is concentrated in the first 48 hours. [9][23]", "Rapid-access TIA systems are appropriate only when they replace, rather than defer, urgent evaluation and preventive treatment. Fast-track care with timely treatment has been associated with similar long-term stroke risk in DWI-positive and DWI-negative TIA cohorts, underscoring the value of prompt organized assessment rather than DWI status alone. [14]" ], "bullets": [ "At discharge, identify the exact service responsible for reviewing vascular and rhythm-monitoring results.", "Arrange testing and stroke/TIA follow-up so the complete evaluation occurs within 48 hours. [23]", "Re-route to emergency stroke evaluation for any recurrent, persistent, or new focal neurologic symptom." ], "subsections": [], "table": { "caption": "Minimum elements of a defensible expedited discharge plan. [9][23]", "columns": [ "Element", "Required documented decision" ], "rows": [ [ "Brain imaging", "State whether DWI-positive infarction is present; if present, manage as ischemic stroke. [12]" ], [ "Vascular evaluation", "Confirm result or scheduled urgent completion; identify whether symptomatic carotid disease requires intervention. [23]" ], [ "Cardiac evaluation", "Record ECG result and whether extended monitoring is needed for cryptogenic disease. [23]" ], [ "Antithrombotic plan", "Specify whether short-term dual antiplatelet therapy, long-term antiplatelet therapy, or anticoagulation assessment is indicated. [4][5][23]" ], [ "Follow-up timing", "Ensure the workup is completed within 48 hours and results have an assigned reviewer. [23]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Supplementary appendix - The Lancet", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/cms/10.1016/S0140-6736(22)01588-4/attachment/c4053be7-fcb8-48b5-9f81-fdf1bf0cb1fc/mmc1.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 2, "title": "Addition of brain and carotid imaging to the ABCD 2 score to identify ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS1474-4422(10)70240-4/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 3, "title": "Diagnosis of non-consensus transient ischaemic attacks with focal ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31961-9/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 4, "title": "Diagnosis and Management of Transient Ischemic Attack ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/2777474", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 5, "title": "Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1800410", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 6, "title": "Comparison of American and European Guideline Recommendations for Diagnostic Workup and Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069651?doi=10.1161%2FCIRCULATIONAHA.124.069651", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 7, "title": "Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.107.189063", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 8, "title": "New evidence-based guidelines for the management of transient ischemic attack | Nature Reviews Neurology", "detail": "www.nature.com", "url": "https://www.nature.com/articles/ncpneuro0328", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 9, "title": "Validation and Refinement of the ABCD2 Score", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.109.553446", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 10, "title": "ABCD3 and ABCD3-I Scores Are Superior to ABCD2 Score in the Prediction of Short- and Long-Term Risks of Stroke After Transient Ischemic Attack", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.113.003077", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 11, "title": "Transient Ischemic Attack | Annals of Internal Medicine - 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American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/09/18/13/32/comparison-of-american", "authors": "www.acc.org", "host": "www.acc.org" }, { "number": 24, "title": "AHA/ASA Stroke Secondary Prevention Guideline: Key Points", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/06/02/18/08/2021-guideline-for-the-prevention-of-stroke", "authors": "www.acc.org", "host": "www.acc.org" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Supplementary appendix - The Lancet", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/cms/10.1016/S0140-6736(22)01588-4/attachment/c4053be7-fcb8-48b5-9f81-fdf1bf0cb1fc/mmc1.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "AHA/ASA Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals", "score": 0.58919704 }, { "number": 2, "title": "Addition of brain and carotid imaging to the ABCD 2 score to identify ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS1474-4422(10)70240-4/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "The ABCD2 score improves stratification of patients with transient ischaemic attack by early stroke risk. We aimed to develop two new", "score": 0.5835125 }, { "number": 3, "title": "Diagnosis of non-consensus transient ischaemic attacks with focal ...", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31961-9/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "We found that non-consensus TIAs had high early and long-term risks of stroke and had cardiovascular pathological findings on investigation", "score": 0.27195793 }, { "number": 4, "title": "Diagnosis and Management of Transient Ischemic Attack ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/2777474", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by SJ Mendelson · 2021 · Cited by 1000 — Dual antiplatelet therapy initiated within 24 hours of symptom onset and continued for 3 weeks reduces stroke risk in select patients with high", "score": 0.56661874 }, { "number": 5, "title": "Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1800410", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor", "score": 0.19980752 }, { "number": 6, "title": "Comparison of American and European Guideline Recommendations for Diagnostic Workup and Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069651?doi=10.1161%2FCIRCULATIONAHA.124.069651", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "In this paper, we compare the recommendations for stroke workup and secondary prevention of ischemic stroke and transient ischemic attack of the American Heart Association (AHA)/American Stroke Association (ASA) with the European Stroke Organization (ESO) guidelines. We compared AHA/ASA with the ESO", "score": 0.7668008 }, { "number": 7, "title": "Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.107.189063", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The American Heart Association/American Stroke Association (AHA/ASA) Writing Committee for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack (TIA) has reviewed the results of recent trials that were published after our previous recommendations were issued.1 Our intention", "score": 0.657297 }, { "number": 8, "title": "New evidence-based guidelines for the management of transient ischemic attack | Nature Reviews Neurology", "detail": "www.nature.com", "url": "https://www.nature.com/articles/ncpneuro0328", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Transient ischemic attack (TIA) is often a precursor to major ischemic stroke, and appropriate management of the condition is, therefore, highly important. Currently, considerable variation exists in how the condition is managed, and the majority of published treatment guidelines are several years o", "score": 0.5227632 }, { "number": 9, "title": "Validation and Refinement of the ABCD2 Score", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.109.553446", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Patients who were not evaluated within 3 days of symptoms were excluded because the maximal risk of stroke after a TIA occurs during the first 48 hours.1–4 Patients received a clinical symptom score of 2 (unilateral weakness) only if there was a reliable description of loss of muscle strength or wea", "score": 0.7548612 }, { "number": 10, "title": "ABCD3 and ABCD3-I Scores Are Superior to ABCD2 Score in the Prediction of Short- and Long-Term Risks of Stroke After Transient Ischemic Attack", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.113.003077", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "In the ABCD3-I score, the presence of abnormal findings on neuroimaging (ie, carotid stenosis or abnormal acute diffusion-weighted image [DWI] on brain magnetic resonance imaging [MRI]) was further added to the ABCD3 score.7 Moreover, recent studies have shown that intracranial arterial stenosis was", "score": 0.7004242 }, { "number": 11, "title": "Transient Ischemic Attack | Annals of Internal Medicine - ACP Journals", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-154-1-201101040-01001", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "TIA is as an important warning that a person is at increased short-term risk for stroke, and early recognition and rapid treatment may", "score": 0.3089408 }, { "number": 12, "title": "Best Clinical Practice: Controversies in Transient Ischemic Attack Evaluation and Disposition in the Emergency Department", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0736467916309040", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Lancet (1992) \n S.C. Johnston _et al._\n### Prevalence and knowledge of transient ischemic attack among US adults\n\n### Neurology (2003) \n D. Kleindorfer _et al._\n### Incidence and short-term prognosis of transient ischemic attack in a population-based study\n\n### Stroke (2005) \n W.N. Kernan ", "score": 0.69820654 }, { "number": 13, "title": "Clinical presentations and dispositions of transient ischemic attack ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/hkj2.12048", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Objective To assess the dispositions, management, and clinical outcomes of TIAMS patients in ED to improve the quality of management in ED.", "score": 0.51969254 }, { "number": 14, "title": "Transient Ischemic Attack Fast-track and Long-Term Stroke Risk: Role of Diffusion-Weighted Magnetic Resonance Imaging - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1052305715002852", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Transient Ischemic Attack Fast-track and Long-Term Stroke Risk: Role of Diffusion-Weighted Magnetic Resonance Imaging - ScienceDirect\n# Original Article Transient Ischemic Attack Fast-track and Long-Term Stroke Risk: Role of Diffusion-Weighted Magnetic Resonance Imaging. However, to date, lim", "score": 0.6803909 }, { "number": 15, "title": "Improving the Prediction of Stroke or Death After Transient Ischemic Attack (TIA) by Adding Diffusion-weighted Imaging Lesions and TIA Etiology to the ABCD2 Score - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1052305712000833", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "However, several issues remain to be clarified before the scores can be judged suitable for wider use. First, few validation studies of imaging-based scores have been done, with limitations such as small sample sizes and inclusion of patients imaged with brain CT, which has lower sensitivity than MR", "score": 0.66959417 }, { "number": 16, "title": "Comparison of Stroke Prediction Accuracy of ABCD2 and ABCD3-I in Patients with Transient Ischemic Attack: A Meta-Analysis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1052305717302604", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation\n\n### Health Technol Assess\n\n## Cited by (12)\n\n### Initiation of the ABCD3-", "score": 0.6180666 }, { "number": 17, "title": "2016 ESC Guidelines for the management of atrial fibrillation ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/europace/article/18/11/1609/2437601", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Initiation or continuation of anticoagulation in atrial fibrillation patients after a stroke or transient ischaemic attack. This approach is", "score": 0.5617203 }, { "number": 18, "title": "Management of carotid stenosis for primary and secondary ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurheartjsupp/article/22/Supplement_M/M35/6024770", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by E Messas · 2020 · Cited by 122 — Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: systematic review and meta-analysis of", "score": 0.5167668 }, { "number": 19, "title": "Poster Abstracts | European Stroke Journal - Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/esj/article/2/1_suppl/98/8275536", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Background and Aims: There are 46,000 first incidences of TIA in the UK annually1. 15% of ischaemic strokes are preceded by TIA, and 1/12 patients who have a TIA, have a stroke within a week2. The greatest risk is in the first few days3–4, hence the need for rapid-access clinics where Stroke special", "score": 0.41279107 }, { "number": 20, "title": "A review of stroke in pregnancy: incidence, investigations and ...", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12624", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "21 In patients presenting with minor stroke or transient ischaemic attacks, treatment with dual antiplatelet therapy (aspirin and", "score": 0.34488514 }, { "number": 21, "title": "The role of cardiologists in stroke prevention and treatment", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurheartj/article/39/17/1567/4096421", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Recent trials in Asian population are in favour of double antiplatelet therapy in the first three months post minor stroke or transient ischemic", "score": 0.26640186 }, { "number": 22, "title": "National Stroke Association guidelines for the management of transient ischemic attacks - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/16912978", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "An official website of the United States government. Federal government websites often end in .gov or .mil. ## Save citation to file. ## Email citation. Go to My NCBI account settings to confirm your email and then refresh this page. ### Add to Collections. ### Add to My Bibliography. ## Create a fi", "score": 0.67501575 }, { "number": 23, "title": "American and European Guideline Comparison for Ischemic Stroke and TIA: Key Points - American College of Cardiology", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/09/18/13/32/comparison-of-american", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "4. Key topics of agreement between the AHA/ASA and ESO guidelines include long-term antiplatelet use to reduce recurrent stroke; screening for carotid stenosis; consideration of long-term cardiac monitoring for cryptogenic stroke; short-term dual antiplatelet therapy after non-cardioembolic minor is", "score": 0.6350646 }, { "number": 24, "title": "AHA/ASA Stroke Secondary Prevention Guideline: Key Points", "detail": "www.acc.org", "url": "https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2021/06/02/18/08/2021-guideline-for-the-prevention-of-stroke", "authors": "www.acc.org", "host": "www.acc.org", "snippet": "#\n\n Become a Member\n\n Contact Us\n\n< Back to Listings\n\n# AHA/ASA Stroke Secondary Prevention Guideline: Key Points\n\nJun 02, 2021 | Eric Elsner Adelman, MD \n\nFont Size\n: A\n: A\n: A\n\nAuthors:\n: Kleindorfer DO, Towfighi A, Chaturvedi S, et al.\n\nCitation:\n: [2021 Guideline for the Prevention ", "score": 0.6108487 } ], "publishedAt": "2026-09-15T21:13:33.499808+00:00", "updatedAt": "2026-09-15T21:13:33.499808+00:00", "readingMinutes": 7, "slug": "transient-ischemic-attack-evaluation" }