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TIAs: How big of a deal are they?
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An 87 year old woman presents to the ED after recently suffering a TIA (Transient Ischemic Attack). Her daughter is with her and says that her speech was impaired for about 25 minutes, and she also noticed unilateral weakness of the extremities. This was her first TIA, and she has a past medical history of NIDDM.
Vitals: HR 74 beats/min, BP 150/95 mmHg, RR 16/min, Temp. 36.7 Centigrade
What is this woman's risk of having an ischemic stroke in the next 48 hours?
Responses:
choose the best one answer
Explanation:
First, don't get mad if you're a medical student, because this question requires some specific knowledge of recent primary literature. This is here as a learning question, and everything needed to answer this question will be explained here. The question is based on the following paper published in the Lancet in 2007 (Rothwell et al. Lancet 2007;369:283-92)
When a patient presents to the ED with a TIA, they can be risk-stratified according to the ABCD^2 scoring system, as follows:
A = Age > 60 - 1 point
B = Blood Pressure > 140/90 mmHg - 1 point
C = Clinical features - Unilateral weakness - 2 points
Speech impairment without weakness - 1 point
D = Duration - >60 minutes - 2 points
10-59 minutes - 1 point
PMH of Diabetes confers 1 extra point, for a maximum total of 7 points (Note: For C and D, the maximum point score is 2 points, they do not add up)
Now, applying these figures to the history avbove, you can see that the ABCD^2 score is 6 of 7 because it does not last for >60 minutes.
Risk stratification is into high, medium and low risk for completion of the ischemic stroke within 48 hours.
High risk - 6-7 points - 8.1% chance of ischemic stroke within 48 hours
Medium risk - 4-5 points - 4% chance of ischemic stroke within 48 hours
Low risk - 0-3 points - 1% chance of ischemic stroke within 48 hours
Therefore, she has an 8% chance of ischemic stroke in the next 48 hours, and must be managed promptly and correctly.
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