Sept 2015 Transient Ischemia Attack

echoecho's version from 2015-10-27 02:16


Question Answer
Define transient ischemia attack (TIA)?a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia WITHOUT cerebral infarction
Although older definitions of TIA included a length of neurological symptoms, is this currently the case?no
What imaging of the brain is recommended to look for evidence of tissue damage and to distinguish TIA from stroke?MRI brain
More than 240,000 TIAs are diagnosed in the US annually with a high rate of progression to stroke (about ____% in the first year), yet the mgmt of TIA is highly variable?12
List the same risk factors shared by TIAs and strokes?HTN, increasing age, dyslipidemia, tobacco abuse, DM and hx of previous TIA or stroke
The challenge is to differentiate patients who are at high risk for _____ from those who are less likely to progress to this?stroke
What tool is used to aid in predicting which patients with TIA will progress to stroke in the short term?ABCD2
Explain the ABCD2 scoring system?1) Age > 60 = 1 point 2) Blood pressure > 140/90 at original presentation = 1 point 3) Clinical features of TIA like unilateral weakness = 2 points; speech disturbance WITHOUT weakness = 1 point 4) Duration of symptoms, if 10-59 minutes = 1 point, if > 60 minutes = 2 points 5) Diabetes mellitus present = 1 point
What is the two-day risk of stroke for 0-1 points?0%
What is the two-day risk of stroke for 2-3 points?1.3%
What is the two-day risk of stroke for 4-5 points?4.1%
What is the two day risk of stroke for 6-7 points?8.1%
Are there any randomized trials that demonstrate the utility of using ABCD2 for triage decisions?no
Are there any randomized trials to evaluate the benefits of hospitalization of patients with TIA?no
What is the theoretical benefit of hospitalization?rapid ability to administer thrombolysis in the case of progression to stroke
The American Stroke Association (ASA) recommends when to hospitalize a patient?1) if they present within 72 hours of the event 2) the ABCD2 score is > 3
Lower scores in patients may be considered for admission if what is present?uncertainty that the diagnostic work-up can't be completed w/in 2 days as an outpatient
A study of the usefulness of the ABCD2 score including 676 patients with a score < 4 showed that 20% of these "low-risk" patients had what?high risk disease required immediate treatment
Therefore, with no prospective trials, the optimal way to differentiate high-risk from low-risk patients with TIA is through what?expert opinion
*** Which patient should be admitted to the hospital and what prompt imaging shoulder be done?1) high risk for stroke patients (ABCD2 score > 3) 2) MRI (magnetic resonance imaging with diffusion-weighted imaging AND of the cervicocephalic vessels w/ either a plain CT or a MRA (magnetic resonance angiography)
Patient should also be evaluated for individual ____ factors?risk
For those patients not on antiplatelet therapy, the ASA (American Stroke Association) recommends what treatment? What alternative treatment if allergic to aspirin?1) ASA monotherapy (50-325 mg/day) OR the combination aspirin 25 mg/dipyridamole 200 mg (Aggrenox) BID 2) Clopidogrel (Plavix) 75 mg daily
Studies suggest that initiation of dual antiplatelet therapy (ASA and clopidogrel) within ____ hours of symptom onset and continuation for ___ days may reduce the risk of subsequent ischemic stroke?24; 21
Are there any studies that have proven the best antiplatelet strategy for patients who suffer a TIA while taking ASA?no
What procedure should be done on all TIA patients?EKG
What procedure should be done if a source of TIA has not been identified?echocardiogram
What blood work should be done?CBC, chem panel, PT, PTT, lipid
*** All patients evaluated for TIAs should have BP control less than what BP? What meds are typically used to keep BP in control? 140/90; ACEI or a thiazide diuretic
*** All patients evaluated for TIAs should be counseled about tobacco cessation, receive statins and if diabetic be treated how?to glycemic control
Define CHADS2 score?it is an assessment to determine whether patients with atrial fibrillation should receive anticoagulation
Define TIMI score?informs clinicians about the risk of MI in patients with chest pain
Define APACHE score?it is a mortality predictor in critical care patients
Define Reynolds score?is a way for patients who are healthy and w/o DM to predict risk of having a future MI, CVA or other major heart disease in the next 10 years
*** SUMMARY - The ABCD2 tool may be used for what?predicting which patients with TIA will progress to stroke in the short term
*** SUMMARY - It is reasonable to hospitalize patients with TIA if they present within ____ hours of the event and the ABCD2 score > ____?72; 3
*** SUMMARY - imaging of the brain is recommended using what imaging?MRI with diffusion -weighted imaging
*** SUMMARY - is antiplatelet therapy recommended?yes