Cerebrovascular Disease/Transient Ischemic Attack

Abstract

Transient ischemic attacks (TIAs) are temporary focal neurologic deficits attributed to temporary arterial ischemia, usually lasting minutes to hours, but not up to 24 hours, as conventionally believed. The clinician must take care in assessing the history of TIA since its character will offer clues as to its etiology. The most common causes of TIAs are extracranial occlusive disease, that is, carotid bifurcation stenosis, and cardiogenic emboli, predominantly from arrhythmias, primarily atrial fibrillation. Evaluations to discover the cause(s) of TIAs should begin in the hospital as soon as possible, because of the high occurrence of strokes in the vascular distribution of the carotid bifurcation stenosis and with cardiogenic emboli in the first 2 weeks of symptom onset. Important in the treatment of TIAs due to carotid bifurcation stenosis (≥70%) is carotid endarterectomy by an experienced surgeon or in some cases carotid artery stenting; important for cardiogenic emboli is anticoagulation with warfarin to keep the international normalized ratio (INR) between 2.0 and 3.0. As emphasized in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the JNC-7 report, healthful lifestyle changes are an important part of reducing vascular risks. But critical to the success of implementing these behavioral changes is the active and committed involvement of the physicians in motivating their patients. Transient ischemic attack is an important warning symptom for a potentially devastating stroke and therefore requires a workup for its cause(s) with institution of appropriate preventative therapy. KeywordsTransient Ischemic AttackStroke PreventionCarotid EndarterectomyCarotid StenosisMoyamoya DiseaseThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.