Early recognition and treatment of TIA
Prof. Pierre Amarenco, Paris, France
TIA was defined in 2002 as “a brief episode of neurologic dysfunction cause by focal brain or retinal ischaemia with clinical symptoms lasting less than one hour”. However, this has recently been updated to include the phrase “and without evidence of acute infarction”: thus implying the need for imaging in order for a diagnosis of TIA to be made. Following a TIA, the chance of having a completed stroke is 15% within 90 days. Furthermore, 23% of strokes are preceded by a TIA, of which 17% occur the same day and 9% the day before. Rapid intervention following a TIA is therefore of key importance.
A “very early management” in TIA clinic which was set up in Paris (“SOS TIA”) resulted in an 80% reduction in the risk of stroke at 3 months. Here, any patient with a TIA was admitted to hospital, 300mg of Aspirin administered and investigations undertaken to determine the cause of their symptoms. However, this approach is not in line with the current ABCD2 scoring system, which recommends that anyone with a score of less than 4 need only be assessed within 7 days of the onset of their symptoms. However, there is evidence to suggest that 20% of these people will have pathological features requiring intervention (e.g. carotid plaques) and therefore, earlier imaging is of value. Indeed, in the SOS TIA project 65% of patients were shown to have some form of carotid atherosclerosis whilst 14% had intracranial stenoses. Imaging enables risk stratification since those with ischaemic lesions on an MRI will have a much higher chance of a future stroke than those without. Rapid assessment for all patients following a TIA is therefore advocated.
View the EPCCS Expert Opinion
Prof. Pierre Amarenco discusses the importance of early recognition and treatment of TIAs to ensure a better prognosis.