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1. Letizia Maria Cupini Centro Cefalee e Malattie Cerebrovascolari U.O.C. Neurologia Ospedale S. Eugenio, Roma Definizione e valutazione degli Attacchi Ischemici Transitori In accordo alle indicazioni dell’AHA/ASA Stroke Council 2009
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3. A large region of DWI and ADC imaging abnormality in the right temporal lobe in a patient with a left hemiparesis that rapidly resolved within 5 hours of onset. a, DWI image; b, ADC image; and c, baseline T2-weighted image. Kidwell et al, Stroke 1999 Diffusion MR sequences show an abnormality in the right cerebral peduncle of the midbrain in a patient presenting with 16 hours of transient left hemiparesis. Repeat MRI 5 months later shows an infarct in the same region. a, DWI image; b, ADC image; c, baseline T2-weighted image; and d, late (follow-up) T2-weighted image. Kidwell et al, Stroke 1999
4. TIA with multiple acute infarcts on DWI. A 70-year-old woman presented with new onset of left-sided numbness and weakness lasting 40 seconds. MRI was performed at 1 day and 7 hours after symptom onset. FLAIR sequence revealed multiple age-indeterminate infarcts (A), while DWI revealed multiple small acute abnormalities (B). Stroke April 2003
6. TIA: la prognosi a 3 mesi *Adverse events=stroke, CV hospitalization, death, or recurrent TIA. 1707 patients with TIA identified by emergency department physicians . CV=cardiovascular. Johnston SC, et al. JAMA . 2000;284:2901-2906. Probability of Survival Free From Stroke and Adverse Events 1.0 0.9 0.8 0.7 0.6 0 7 30 60 90 Stroke 10.5% Days After TIA Adverse events* 25.1%
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9. ABCD2 score for stroke risk after TIA 2 if ≥ 60 minutes 2 if unilateral weakness 1 present 1 if 10 to 59 minutes 1 if speech disturbance without weakness 1 if systolic ≥ 140 mmHg and/or diastolic ≥ 90 mmHg 1 if ≥60 years 0 none 0 if less than 10 minutes 0 other than specified 0 normal 0 if <60 years Diabetes mellitus Duration Clinical Features Blood Pressure Age
11. Time-dependent 5-yrs benefit of endarterectomy for symptomatic stenosis >70% stenosis 50-69% stenosis Rothwell, Eur J Vasc Endovasc Surg 2008
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Hinweis der Redaktion
Patients who present in emergency department with transient ischemic attacks (TIA) are at risk for stroke and other adverse events. In this study of 1707 patients with TIA, 10.5% experienced a stroke within 90 days and 25.1% experienced an adverse event (including stroke, cardiovascular hospitalization, death, or recurrent TIA). Key Point: The short-term risk of stroke and other adverse events among patients who present to an emergency department with a TIA is substantial. Characteristics of the patient and the TIA may be useful for identifying patients who may benefit from expeditious evaluation and treatment.
In combined validation cohorts, the 2-day risk of stroke was 0% for scores of 0 or 1, 1.3% for 2 or 3, 4.1% for 4 or 5, and 8.1% for 6 or 7. It is likely to be used in most future work but not yet had full validation[2] although it seems better than the ABCD and california scores at risk stratification after TIA and minor ischaemic stroke[3]. The maximum score is 7
Fig. 2. Pooled analysis of data from randomized controlled trials of endarterectomy for symptomatic carotid stenosis shows the absolute reduction with surgery in the 5-year risk of ipsilateral carotid territory ischemic stroke and any stroke or death within 30 days after trial surgery in patients with 50% to 69% stenosis and 70% or more stenosis without near-occlusion stratified by the time from last symptomatic event to randomization. The numbers above the bars indicate the actual absolute risk reduction. ARR, absolute risk reduction. ( Data from Rothwell PM, Eliasziw M, Gutnikov SA, et al, for the Carotid Endarterectomy Trialists Collaboration. Effect of endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and to the timing of surgery. Lancet 2004;363:923.) The absolute reduction with surgery in the five year risk of stroke and operative death in patients stratified by the time from last symptomatic event to randomisation in a pooled analysis of data from randomised trials of endarterectomy for recently symptomatic carotid stenosis.
