This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the author's clinicalrecommendations.
A 72-year-old woman telephones her physician immediately afterrecovering from a 30-minute episode of difficulty speaking andweakness of the right side of the face and right arm. Her medicalhistory is unremarkable. How should she be treated?
The Clinical Problem
In the United States, estimates of the annual incidence of transientischemic attacks that come to medical attention vary from 200,000to 500,000. The . . . [Full Text of this Article]
Strategies and Evidence
Risk of Stroke after Transient Ischemic Attack
Evaluation
Treatment
Aspirin and Other Antiplatelet Agents
Anticoagulant Therapy
Carotid Endarterectomy
Treatment of Risk Factors for Cardiovascular Disease
Areas of Uncertainty
Guidelines
Conclusions and Recommendations
Source Information
From the Departments of Neurology and EpidemiologyBiostatistics, University of CaliforniaSan Francisco, San Francisco.
Address reprint requests to Dr. Johnston at the Department of Neurology, Box 0114, University of CaliforniaSan Francisco, 505 Parnassus Ave., M-798, San Francisco, CA 94143-0114, or at clay.johnston@ucsfmedctr.org.
Easton, J. D., Saver, J. L., Albers, G. W., Alberts, M. J., Chaturvedi, S., Feldmann, E., Hatsukami, T. S., Higashida, R. T., Johnston, S. C., Kidwell, C. S., Lutsep, H. L., Miller, E., Sacco, R. L.
(2009). 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: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.. Stroke
40: 2276-2293
[Abstract][Full Text]
Ford, M. A., Reeder, G. S., Lennon, R. J., Brown, R. D., Petty, G. W., Cabalka, A. K., Cetta, F., Hagler, D. J.
(2009). Percutaneous Device Closure of Patent Foramen Ovale in Patients With Presumed Cryptogenic Stroke or Transient Ischemic Attack: The Mayo Clinic Experience. J Am Coll Cardiol Intv
2: 404-411
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van der Worp, H. B., van Gijn, J.
(2007). Acute Ischemic Stroke. NEJM
357: 572-579
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Danielyan, K., Ding, B.-S., Gottstein, C., Cines, D. B., Muzykantov, V. R.
(2007). Delivery of Anti-Platelet-Endothelial Cell Adhesion Molecule Single-Chain Variable Fragment-Urokinase Fusion Protein to the Cerebral Vasculature Lyses Arterial Clots and Attenuates Postischemic Brain Edema. J. Pharmacol. Exp. Ther.
321: 947-952
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Bray, J. E, Coughlan, K., Bladin, C.
(2007). Can the ABCD Score be dichotomised to identify high-risk patients with transient ischaemic attack in the emergency department?. Emerg. Med. J.
24: 92-95
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Zaitsev, S., Danielyan, K., Murciano, J.-C., Ganguly, K., Krasik, T., Taylor, R. P., Pincus, S., Jones, S., Cines, D. B., Muzykantov, V. R.
(2006). Human complement receptor type 1-directed loading of tissue plasminogen activator on circulating erythrocytes for prophylactic fibrinolysis. Blood
108: 1895-1902
[Abstract][Full Text]
Ganguly, K., Goel, M. S., Krasik, T., Bdeir, K., Diamond, S. L., Cines, D. B., Muzykantov, V. R., Murciano, J.-C.
(2006). Fibrin Affinity of Erythrocyte-Coupled Tissue-Type Plasminogen Activators Endures Hemodynamic Forces and Enhances Fibrinolysis in Vivo. J. Pharmacol. Exp. Ther.
316: 1130-1136
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Kasner, S. E., Chimowitz, M. I., Lynn, M. J., Howlett-Smith, H., Stern, B. J., Hertzberg, V. S., Frankel, M. R., Levine, S. R., Chaturvedi, S., Benesch, C. G., Sila, C. A., Jovin, T. G., Romano, J. G., Cloft, H. J., for the Warfarin Aspirin Symptomatic Intracranial,
(2006). Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis. Circulation
113: 555-563
[Abstract][Full Text]
Knoll, G., Cockfield, S., Blydt-Hansen, T., Baran, D., Kiberd, B., Landsberg, D., Rush, D., Cole, E., for The Kidney Transplant Working Group of the Can,
(2005). Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ
173: S1-S25
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The Paul Coverdell Prototype Registries Writing Gr,
(2005). Acute Stroke Care in the US: Results from 4 Pilot Prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke
36: 1232-1240
[Abstract][Full Text]
Chimowitz, M. I., Lynn, M. J., Howlett-Smith, H., Stern, B. J., Hertzberg, V. S., Frankel, M. R., Levine, S. R., Chaturvedi, S., Kasner, S. E., Benesch, C. G., Sila, C. A., Jovin, T. G., Romano, J. G., the Warfarin-Aspirin Symptomatic Intracranial Dise,
(2005). Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis. NEJM
352: 1305-1316
[Abstract][Full Text]
Johnston, S. C.
(2004). Ischemic Preconditioning From Transient Ischemic Attacks?: Data From the Northern California TIA Study. Stroke
35: 2680-2682
[Abstract][Full Text]
Josephson, S. A., Bryant, S. O., Mak, H. K., Johnston, S. C., Dillon, W. P., Smith, W. S.
(2004). Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology
63: 457-460
[Abstract][Full Text]
Gladstone, D. J., Kapral, M. K., Fang, J., Laupacis, A., Tu, J. V.
(2004). Management and outcomes of transient ischemic attacks in Ontario. CMAJ
170: 1099-1104
[Abstract][Full Text]
Douglas, V. C., Johnston, C. M., Elkins, J., Sidney, S., Gress, D. R., Johnston, S. C.
(2003). Head Computed Tomography Findings Predict Short-Term Stroke Risk After Transient Ischemic Attack. Stroke
34: 2894-2898
[Abstract][Full Text]
Nguyen-Huynh, M. N., Fayad, P., Gorelick, P. B., Claiborne Johnston, S.
(2003). Knowledge and management of transient ischemic attacks among US primary care physicians. Neurology
61: 1455-1456
[Full Text]
Johnston, S. C., Easton, J. D.
(2003). Are Patients With Acutely Recovered Cerebral Ischemia More Unstable?. Stroke
34: 2446-2450
[Abstract][Full Text]
Graham, C. A.
(2003). Editorial Comment--Transient Cerebral Ischemia Demands Urgent Evaluation. Stroke
34: 2451-2452
[Full Text]
Eimer, M. J., Rajamannan, N. M., Johnston, S. C.
(2003). Transient Ischemic Attack. NEJM
348: 1606-1606
[Full Text]
(2003). A Proposed New Definition for TIA. JWatch Emergency Med.
2003: 2-2
[Full Text]