↑ Douglas VC, Johnston CM, Elkins J, et al.CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. ↑ Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, Koroshetz WJ, Gonzalez RG.Transient ischemic attack: proposal for a new definition. ACEP Clinical Policy: Suspected Transient Ischemic Attack.And/or fluctuating or persistent symptoms without motor weakness or language/speech disturbance.Transient, fluctuating or persistent language/speech disturbance.
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Transient, fluctuating or persistent unilateral weakness (face, arm and/or leg).Very high risk for recurrent stroke are the following symptoms that have occurred within the last 48 hours.According to the 2018 Canadian Heart and Stroke Guideline, the Clinical component of the ABCD2 score is the most important prognostic feature.Although prognostic, evidence-based admission thresholds have not been determined.Risk of stroke at 2d, 7d, and 90d from TIA.Risk of Stroke or Carotid Revascularization in 7 Days 2.Infarction (new or old) on computed tomography (1 pt).1.Atrial fibrillation on electrocardiogram (2 pt).Investigations in the emergency department:.Dysarthria or aphasia (history or examination) (3 pt) Initial triage diastolic blood pressure ≥110 mm Hg (3 pt) The score offers better performance than ABCD2 in predicting stroke risk after TIA, particularly low risk.Study based on observation units and outpatient TIA clinics Įxample of a rapid ED protocol for TIA Prognosis Canadian TIA Score.Level B: A rapid ED based diagnostic protocol can be used to safely identify patients at short-term risk for stroke.None have demonstrated the ability to identify individual patients at sufficiently low short-term risk for stroke to use alone as a risk-stratification instrument. Multiple other risk-stratification instruments have been evaluated less frequently than the ABCD2 score.In contrast to the 2009 AHA/ASA recommendations that were based on limited research, the ABCD2 does not sufficiently identify the short-term risk for stroke to use alone as a risk-stratification instrument.Level B: In adult patients with suspected TIA, do not rely on current existing risk stratification instruments (eg, age, blood pressure, clinical features, duration of TIA and presence of diabetes score) to identify TIA patients who can be safely discharged from the ED.Load with Clopidogrel 300 mg PO followed by 75 mg daily for 3 weeks only.Load with Aspirin 325 mg chewed, followed by ASA 81 mg PO daily.Consider dual antiplatelet therapy for high risk TIA (ABCD2 score ≥ 4).Consider Aspirin 325 mg PO (once hemorrhage ruled-out) for low risk TIA (ABCD2 score Little acute management (given normally resolution of symptoms).May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C).Cervical vascular imaging (ACEP Level B in patients with high short-term risk for stroke):.MRI Brain with DWI, ADC (without contrast) AND.
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In large ICH or stroke, may see deep TWI and prolong QT, occ ST changes.Seizures/postictal paralysis (Todd paralysis).Vision changes (Field deficits, blindness, or diplopia)ĭifferential Diagnosis Stroke-like Symptoms.Focal weakness (Paralysis or paresis of the face, arm, or leg and typically unilateral).Since 15% of strokes are preceded by TIA, timely eval of high risk conditions like Atrial Fibrillation and Carotid Stenosis is important.Classic Definition: A sudden, focal neurologic deficit that lasts for less than 24 hours, is presumed to be of vascular origin, and is confined to an area of the brain or eye perfused by a specific artery.Should be viewed as analogous to unstable angina.New Definition: a brief episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction.4.2 MR Imaging (for Rule-Out CVA or TIA).