The patient with transient cerebral ischemia: a golden opportunity for stroke prevention

Abstract

Transient ischemic attack (TIA) provides a golden opportunity for stroke prevention. TIA should be treated as a medical emergency with prompt investigations to determine the mechanism of ischemia and subsequent preventive therapy. The risk of stroke after TIA is estimated to be 10%-20% in the first 90 days. The risk is time-dependent with 50% of the risk accruing in the first 48 hours. In this review, we describe the diagnosis and management of TIA, introduce new concepts in TIA and suggest that all patients with significant TIA should undergo rapid investigation and management to prevent stroke.

Box 1

Fig. 1: Diffusion-weighted MRI showing an acute large stroke in the right middle cerebral artery territory. This patient had had a right-hemisphere transient ischemic attack (TIA) several days before admission but had not sought medical attention. Unfortunately, he presented to the hospital late and was not eligible for treatment with tissue plasminogen activator (tPA).

Fig. 2: Left: Contrast-enhanced magnetic resonance angiogram of the right carotid artery showing a tight stenosis (> 70%) of the right internal carotid artery just distal to the bifurcation. Right: Formal selective cerebral angiogram showing the same lesion. The patient had had a TIA and was enrolled in a clinical trial in which he received carotid angioplasty and stenting to treat his symptomatic carotid stenosis.