emDocs - October 31, 2016 - Author: Long B - Edited by: Koyfman A
"Summary
- TIA is defined as a brief episode of neurologic dysfunction with no permanent infarction. Over 200,000 patients per year in the U.S. are affected, and this disease may precede approximately 20% of strokes.
- Patients are typically admitted for inpatient management due to this risk of future stroke. A great deal of literature has evaluated the use of imaging, clinical risk scores, and diagnostic protocols in the evaluation of TIA.
- Head CT noncontrast is not reliable for acute ischemia, but it can find alternative conditions necessitating management. MRI with DWI displays greater diagnostic ability. Carotid imaging includes MRA, CTA, and Doppler with US. MRA and Doppler US demonstrate similar test characteristics.
- Risk scores that predict future stroke are not reliable when used alone.
- The use of ED diagnostic protocols and observation units can reduce length of stay while improving patient treatment and reducing stroke rate.
- Careful evaluation of risk factors and imaging may allow the patient to be discharged with follow up within 24 hours for further evaluation."