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Does transient ischemic attack deserve emergency care?

Nature Clinical Practice Neurology volume 2, pages 174–175 (2006)Cite this article

Ischemic strokes are frequently preceded by one or more transient ischemic attacks (TIAs).1 TIAs therefore afford the opportunity for prevention of such strokes. Owing to methodological problems in early studies of prognosis, the immediate risk of stroke after a TIA was, however, underestimated for many years.2 Risks of 1–2% at 7 days and 2–4% at 30 days were widely quoted, but recent hospital-based and population-based prospective cohort studies have shown that the true risk is up to 10% at 7 days and as much as 15% at 30 days.3,4 A study of the timing of TIAs preceding ischemic stroke also showed that the time window for prevention is brief, with 17% of TIAs occurring on the day of the stroke, and 43% during the 7 days prior to the stroke.1

The previous underestimation of the risk of stroke is partly responsible for the considerable international variation in how patients with suspected TIA are managed, with some healthcare systems providing immediate emergency in-patient care and others providing non-emergency outpatient-clinic assessment.5 North American and UK guidelines simply state that all patients in whom a diagnosis of TIA is suspected should be assessed and investigated within 7 days of presentation, although this is frequently not achieved in practice. In a recent population-based study of all patients (n = 853) who had carotid imaging after TIA or minor stroke in Oxfordshire, UK, the median time from presenting event to assessment in secondary care was 9 days (interquartile range 3–30 days).6

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  1. Professor of Clinical Neurology and Director of the Stroke Prevention Research Unit at the University of Oxford, Oxford, UK

    Peter M Rothwell

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  1. Peter M Rothwell
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Correspondence to Peter M Rothwell.

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The author declares no competing financial interests.

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Rothwell, P. Does transient ischemic attack deserve emergency care?. Nat Rev Neurol 2, 174–175 (2006). https://doi.org/10.1038/ncpneuro0114

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