Classic definition: focal cerebral ischemic event with symptoms lasting < 24 hours
2009 AHA/ASA definition: brief episode of neurological dysfunction caused
by focal brain or retinal ischemia, with clinical symptoms typically
lasting less than one hour, and without evidence of acute infarction
Why is there a new definition?
A 24-hour duration of symptoms does not accurately demarcate patients with and without tissue infarction
- new definition focused on imaging rather than duration of symptoms
Annual incidence of is about 200,000 to 500,000 with the population prevalence about 2.3 precent or about 5 million Americans.
10-15% of patients have a stroke
within 3 months, with half occurring within 48 hours
Data supporting early rather than
delayed carotid endarterectomy for TIA patients with carotid stenosis
- Duration ‐ <10min, 10‐60min, >60 min
- Evidence to suggest non‐vascular cause?
- Symptoms to suggest potential causes?
- Arrhythmia, Murmur – Symptoms reproducible with maneuvers?
- CBC, glucose, chemistries, PT
Medical management of risks
- Risk of CVA in 2, 7, 90 days
- Higher score is higher risk
- HTN: BP below 140/90
- DM: fasting glucose < 126 mg/dl
Hyperlipidemia: LDL < 100 mg/dl
Exercise 30‐60 min, 3x/week
Avoid excessive alcohol use
Weight loss: < 120% of ideal weight
Definition and Evaluation of Transient Ischemic Attack: J.
Donald Easton, Jeffrey L. Saver, Gregory W. Albers, Mark J. Alberts,
Seemant Chaturvedi, Edward Feldmann, Thomas S. Hatsukami, Randall T.
Higashida, S. Claiborne Johnston, Chelsea S. Kidwell, Helmi L. Lutsep,
Elaine Miller and Ralph L. Sacco. Stroke 2009, 40:2276-2293: originally
published online May 7, 2009. doi: 10.1161/STROKEAHA.108.192218
Update in the Management of TIA and Stroke Patients. Michael A. Ross,
MD, FACEP. SA-46. 10/15/2011. 3:00 PM - 3:50 PM. Moscone Convention
- Keep SBP < 180 mmHg and/or MAP < 120 mmHg
- IV Bolus Dose
- 2 mg/min, titrate to effect (max 300mg/day)
- 5 mg/hr, titrate to effect (max 15mg/hr)