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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Six studies from 2006-2008 that have influenced clinical management of stroke and threatened stroke are presented. The ABCD2 score effectively stratifies the short-term risk of stroke following transient ischemic attack into those with a high (12%), moderate (6%), and low (1%) 7-day stroke risk. High-dose atorvastatin reduces recurrent stroke in patients with recent stroke, but probably slightly increases central nervous system hemorrhage (SPARCL). Intravenous tissue plasminogen activator is of overall benefit to selected patients when given 3 to 4.5 hours after ischemic stroke onset (ECASS III). Adjusted-dose warfarin is far superior to aspirin and is relatively safe for very old people with atrial fibrillation (BAFTA). Despite results from 3 recent randomized trials (SAPPHIRE, EVA-3S and SPACE) the optimal role of carotid angioplasty/stenting vs. endarterectomy remains unclear. Enoxaparin once daily is an efficacious alternative to unfractionated heparin twice daily for prevention of venous thromboembolism after acute ischemic stroke (PREVAIL). These recent studies add important pieces to the complex puzzle of optimal stroke prevention and treatment.
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PMID:What's new in stroke? The top 10 studies of 2006-2008. Part II. 1920 54

This review is a summary of the New Zealand guideline for the management of Transient Ischaemic Attack (TIA). TIA is a medical emergency and warrants urgent attention. The risk of early stroke following TIA may be as high as 12% at 7 days, and 20% at 90 days, with half of these strokes occurring within the first 48 hours. All people with suspected TIA should be assessed at initial point of health care contact for their risk of stroke. Diagnosis of TIA is more likely to be correct if the history confirms: sudden onset of symptoms, with maximal neurological deficit at onset; symptoms typical of focal loss of brain function such as unilateral weakness or speech disturbance; and rapid recovery, usually within 30-60 minutes. The ABCD2 score is a tool that assists with diagnosis and identifies people most at risk of stroke after TIA. People at high risk of stroke require urgent specialist assessment as soon as possible but definitely within 24 hours. This includes those with ABCD2 scores of 4 or more, crescendo TIAs, atrial fibrillation, or who are taking anticoagulants. People at low risk usually require specialist assessment and investigations within 7 days. This includes those with ABCD2 scores of less than 4 or those who present more than one week after TIA symptoms. As soon as the diagnosis is confirmed, all people with TIA should have their risk factors addressed and be established on an appropriate individual combination of secondary prevention measures including anti-platelet agents, blood pressure-lowering therapy, statin, warfarin (if atrial fibrillation or other cardiac source of emboli), and nicotine replacement therapy or other smoking cessation aid. Urgent assessment and intervention in TIA clinics has been shown to reduce the risk of stroke after TIA by up to 80%. Follow-up, either in primary or secondary care, should occur within 1 month so that medication and other risk factor modification can be reassessed.
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PMID:Preventing strokes: the assessment and management of people with transient ischaemic attack. 1944 85

Stroke is Australia's second single greatest killer with 53 000 new events each year at a rate of 1 every 10 min. Stroke services should be organized to enable people to access proven therapies, such as stroke unit care and thrombolysis, to reduce the impact of stroke. Timely, efficient and coordinated care from ambulance services, emergency services and stroke services will maximize recovery and prevent costly complications and subsequent strokes. Efficient management of patients with transient ischaemic attack can produce significant reductions in subsequent stroke events and risk stratification using the ABCD2 tool can aid management decisions. Evidence for acute stroke care continues to evolve and it is crucial that health professionals are aware of, and implement, best practice clinical guidelines for stroke care.
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PMID:Acute stroke and transient ischaemic attack management--time to act fast. 2063 34

Strategies are required to reduce the personal, societal and healthcare burden caused by cerebrovascular disease. Urgent medical intervention after transient ischaemic attack (TIA) can prevent recurrent stroke, and modern healthcare has to respond rapidly to the patient with TIA. The primary care practitioner contributes to stroke prevention by rapidly and accurately diagnosing TIA and arranging urgent specialist assessment. Diagnosis of TIA in primary care is difficult, as transient symptoms are common. Stroke-screening tools are available, but there is no evidence base for diagnostic support tools for TIA in primary care. The ABCD2 scoring system identifies patients after TIA at high early risk, and secondary care assessment within 24 h is reserved for patients with a high predicted risk. General practitioners are advised to give aspirin at the time of diagnosis, although prescribing a full range of vascular risk-reducing therapies may be appropriate. Specialist assessment confirms the diagnosis, usually with cerebral imaging (preferably MRI to detect cerebral injury), and carotid ultrasound will detect patients suitable for endarterectomy. Patients with suspected stroke should be urgently transferred to the nearest stroke centre, for assessment and investigation before potential thrombolysis, which may be effective within a longer timeframe than current practice. Primary care follow-up is essential to ensure adherence to evidence-based therapies. Dual combinations of antiplatelet agents (aspirin and dipyridamole) and antihypertensive agents (ACE inhibitors and thiazides) as well as high-dose statins have proven benefit. For patients in atrial fibrillation, even if very elderly, anticoagulation has a net benefit in preventing stroke.
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PMID:Initial management of suspected transient cerebral ischaemia and stroke in primary care: implications of recent research. 1963 8

Transient ischemic attack (TIA) is a medical emergency, which has been newly termed as "acute cerebrovascular syndrome" (ACVS). TIA is often ignored or unrecognized by patients or their families since its symptoms are naturally subsided without any treatment. TIA is also usually underestimated or nonprioritized by physicians because it is regarded merely as a minor stroke. However, stroke risk is very high in patients early after TIA. Therefore, rapid evaluation followed by immediate treatment is essential in TIA patients. TIA patients should be directly referred to stroke specialists in TIA clinics to consider hospitalization for specific emergent treatments. Early stroke risk is especially high in TIA patients with a high ABCD2 score of 4 or more (A age over 60 years [1 point]: B blood pressure > 140/90 mmHg [1 point]: C Clinical features, including unilateral weakness [2 points] and speech disturbance without weakness [1 point] D2: Diabetes [1 point] and Duration of symptoms [1 point for < 60 min and 2 points for > 60 min]), acute ischemic lesions on diffusion weighted image, > 50% carotid stenosis, severe intracranial artery stenosis, microembolic signals on transcranial Doppler, atrial fibrillation, or hypercoagulable states. It has been reported that immediate starting treatment with statins, antiplatelet agents, and antihypertensives substantially reduces the risk of stroke within 90 days after TIA. US National Stroke Association guidelines recommend assessments using computed tomography (CT)/ CT angiography (CTA), magnetic resonance imaging (MRI)/MR angiography (MRA), and carotid ultrasonography as well as immediate starting antiplatelet therapy in patients with non-cardioembolic TIA or oral anticoagulant therapy in patients with cardioembolic TIA within 24 hours during the first week after TIA. A large international, multicenter cooperative, observational study (TIA Registry. Org.) on 5,000 patients with TIA or minor stroke within 7 days of onset is being initiated. Now, we should say "Time is TIA".
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PMID:[Transient ischemic attack, a medical emergency]. 1980

The risk of a subsequent stroke following an acute transient ischemic attack or minor stroke is high, with 90-day risk at approximately 10%. Identification of those patients at the highest risk for recurrent stroke following a transient ischemic attack or minor stroke may allow risk-specific management strategies to be implemented, such as hospital admission with expedited work-up for those at high risk and emergency room discharge for those at low risk. Predictors of recurrent stroke, including the ABCD2 score, brain imaging and the stroke mechanism, are reviewed in this article, with a focus on recent literature. An emphasis is placed on the importance of early imaging of the brain parenchyma (diffusion-weighted imaging) and vascular imaging to identify patients at high risk for recurrence. The need for identification of the cause of the initial event, allowing therapies to be tailored to the individual patient, is discussed.
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PMID:Predicting recurrent stroke after minor stroke and transient ischemic attack. 1981 70

Acute hyperglycaemia is associated with poorer outcome in stroke, however limited evidence is available regarding its association with transient ischaemic attack (TIA). This study aimed to determine the association between acute hyperglycaemia and mortality in 194 patients with TIA. Mortality data were obtained from a state-wide death registry. No significant association was identified with either multivariate Cox regression (p=0.65) or Kaplan-Meier analysis (p=0.85). Because of the low death rate, a larger sample is required to reliably exclude an association. Univariate analysis identified significantly associated variables, including TIA clinical prediction scores (e.g. ABCD and ABCD2). Multivariate analysis identified age, atrial fibrillation and duration 1 hour as independent significant predictors of mortality.
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PMID:Acute hyperglycaemia and mortality in patients with transient ischaemic attack. 2008 7

To compare the performance of three risk scores (ABCD, ABCD2 and California) in identification of short-term stroke risk in patients with emergency department (ED) diagnosis of transient ischaemic attack. In the retrospective cohort study, information collected included features of clinical risk scores, demographic, clinical and outcome data. The outcome of interest was new stroke occurrence at 2, 7 and 30 days. Data underwent receiver operating curve analyses. Of 326 patients, 17 patients experienced a new stroke within 30 days (4.9%, 95% confidence interval: 2.9-8.0%). C-statistic for high-stroke risk was not significantly different between scores at 2, 7 or 30 days. Using cutoffs of defined risk score cutoffs, the negative predictive values for stroke within 30 days were 97.4% (California), 99.1% (ABCD) and 98.9% (ABCD2), respectively. All three risk scores predict short-term risk of stroke in patients with an ED diagnosis of transient ischaemic attack and could be an effective tool to guide clinical decision making.
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PMID:Comparison of prognostic performance of scores to predict risk of stroke in ED patients with transient ischaemic attack. 2016 75

ABCD2 score identifies high-risk TIAs but its validity in different countries and hospitals is unknown. Doubts remain also about the role of diagnostic work up for patients with TIAs in the emergency department. The present study was undertaken to confirm the usefulness of ABCD2 score in the emergency department of Trento Hospital and to evaluate if other exams (carotid ultrasound or CT scan) commonly performed in TIA patients are helpful. We retrospectively analysed discharge diagnosis of around 120,000 patients seen at the first aid of Trento Hospital over a 28 month period. ABCD2 score, carotid ultrasound and CT scan were recorded and were correlated with recurrence of stroke at different time points (mean follow-up period of 11.4 months) in all patients with TIA. We identified 965 patients with focal neurologic deficit and 502 could be classified as TIA. An ischemic stroke recurred in 30 patients at the end of the follow-up (30% in the first two days). ABCD2 score confirmed its value. A significant carotid stenosis (>70%) was an independent risk factor for stroke at any time point. Our study confirms the role of ABCD2 in a large Italian cohort of TIA patients but also suggests the importance of performing a carotid ultrasound as soon as possible.
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PMID:Carotid stenosis as predictor of stroke after transient ischemic attacks. 2127 96

Recent findings have externally validated the usefulness of the ABCD2 score in triaging TIA patients with a high risk of early stroke in a multiethnic sample of hospitalized patients. Since this publication some neurologists in the Netherlands and in other countries have suggested that this supports guidelines that endorse the immediate hospitalization of patients with a high risk of TIA. However, no randomized trial has evaluated the benefits of hospitalization or the value of the ABCD2 score in assisting with triage decisions. Current Dutch guidelines on stroke recommend the prescription of medication for secondary prevention immediately after a TIA and a full diagnostic workup within the first few days after TIA onset. In the Dutch setting, a workup in an outpatient TIA clinic is sufficient for starting secondary prevention and selecting patients likely to benefit from carotid surgery. Acute hospitalization is generally not necessary and creates false certainty in preventing a second event.
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PMID:[Acute hospitalization for TIA unnecessary]. 2138 9


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