Abstract 3889: Diagnosis of Transient Ischemic Attack Varies by Neurologist

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Deepa P Bhupali ◽  
Huma U Sheikh ◽  
Daniel L Labovitz
Keyword(s):  
Transient Ischemic Attack ◽  
Chart Review ◽  
Medical Center ◽  
Chi Square ◽  
Duration Of Symptoms ◽  
Medicine Service ◽  
Icd9 Code ◽  
Abcd2 Score ◽  
The Difference ◽  
Ischemic Attack

Introduction: The short duration of symptoms and multitude of non-vascular mimics make diagnosis of transient ischemic attack (TIA) subjective and challenging. Physician practice may influence whether a patient receives the diagnosis of TIA. Pathophysiology is the same for TIA and ischemic stroke (IS). Therefore, the proportion of TIA versus IS diagnoses should be the same across demographic and clinical strata and theoretically should not vary between physicians. Hypothesis: The TIA-IS ratio, defined as the proportion of TIA among all TIA and IS cases, varies between medicine and neurology services and between board-certified vascular and other neurologists. Methods: TIA and IS cases were identified using primary ICD9 discharge codes at Montefiore Medical Center from January 2009 through June 2011. Each TIA diagnosis was confirmed by chart review, excluding cases with acute IS on brain imaging, duration >24 hours or a clearly non-vascular syndrome. The TIA-IS ratio was assessed based on the primary ICD9 code and again on the diagnosis by chart review for discharges from the neurology versus the medicine service and also individually for each board-certified neurologist with more than 25 IS or TIA discharges during the study period. Mantel-Hantsel chi-square was used for univariate statistical comparison between groups. Results: There were 659 cases of TIA and 1927 cases of IS by primary ICD9 discharge code, for an overall TIA-IS ratio of 25.5 %. The ratio was higher for discharges from medicine (28.6%) than neurology services (23.8%, p=0.009). The ratio was higher for 12 non-vascular neurologists (27.0%, range 17.9-44.4%, 904 cases), than 5 vascular neurologists (20.0%, range 18.7-23.0, 715 cases, p=0.001). Chart review reduced the overall TIA-IS ratio to 16.3% and the difference between medicine and neurology discharges became non-significant but non-vascular neurologists still had a higher TIA-IS ratio (20.7%) than vascular neurologists (14.4%, p=0.001). Conclusions: The TIA-IS ratio is different on medicine and neurology services and varies widely among board-certified neurologists, with vascular neurologists less likely to assign the diagnosis of TIA than other neurologists even after excluding obvious non-TIA cases. The ABCD2 score, assessing patients’ symptoms and vascular risk factors, is promoted as a criterion for admission; however, these data suggest that physician training and perspective affect the diagnosis, and thus assessment of future stroke risk, as well.

Abstract 276: Asymmetric Dimethylarginine Is A Potential Risk Factor For Transient Ischemic Attack

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Yuanjin Zhang ◽  
Daniel Laskowitz ◽  
Dongsheng Fan
Keyword(s):  
Growth Factor ◽  
Transient Ischemic Attack ◽  
Asymmetric Dimethylarginine ◽  
Small Sample Size ◽  
Small Sample ◽  
Control Group ◽  
Acute Infarction ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
And Control

Objective: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase which has been shown to be involved in the pathogens of atherosclerosis. Vascular endothelial growth factor (VEGF) is apleiotropic growth factor involved in neurovascular remodeling in the cerebral ischemia disease. ADMA has been validated to be a risk marker of stroke and transient ischemic attack (TIA). VEGF has been demonstrated associated with risk of stroke. This pilot study aimed to verify the correlation between serum ADMA, VEGF levels and ABCD2 score which has been validated to predict short term risk of stroke following transient ischemic attack (TIA). Methods: TIA was defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia, without acute infarction even the focal transient neurologic symptoms last less than one hour. We enrolled 40 TIAs and 40 healthy controls in Peking University Third Hospital Neurology wards and clinics since May to July 2013. The TIA diagnosis and ABCD2 score evaluation is conducted by the same neurology physician. The mean age of TIAs and controls was 61.9±12.9yrs and 63.4±10.9yrs respectively (P=0.544). Blood samples were drawn within 24 hours after the TIA diagnosis clarified. ADMA and VEGF levels were measured by ELISA. Result: The ADMA levels in TIAs and control group are 0.52±0.06mmol/L and 0.23±0.04mmol/L (t=24.14, P<0.01). The VEGF levels in TIAs and control group are 272.01±26.36mmol/L and 148.87±21.05mmol/L (t=24.65, P<0.01). In the non-stroke history TIAs (23 cases) sub-group the spearman correlation coefficient between ADMA and ABCD2 score is 0.6(P=0.002). Conclusion: ADMA and VEGF are absolutely increased in TIAs. There is no correlation between ADMA, VEGF, age, sex, blood pressure, glucose and ABCD2 in this small sample size population. But ADMA is probably associated with risk of TIA with no-stroke history. Thus, these findings reveal a possibly new challenging potential of the ADMA and VEGF role in the pathogenesis of TIA.

scholarly journals GENOTYPE AND ABO BLOOD GROUP ASSOCIATION WITH PREVALENCE OF MALARIA AMONG PATIENTS IN UNIVERSITY OF NIGERIA MEDICAL CENTER: A CROSS-SECTIONAL EVALUATION

2019 ◽  
pp. 28-32
Author(s):  
Abdulmuminu Isah ◽  
Chibueze Anosike ◽  
Chukwuma Stephen Ogbodo ◽  
Charles Obinna Emeka ◽  
Chukwuemeka Sylvester Nworu
Keyword(s):  
Blood Group ◽  
Medical Center ◽  
Pearson Correlation ◽  
Statistical Significance ◽  
Malaria Prevalence ◽  
Abo Blood Group ◽  
Chi Square ◽  
Cross Sectional ◽  
The Difference ◽  
Cross Sectional Design

Objective: The aim of this study was to evaluate the prevalence of malaria and its relationship with the ABO blood group and genotype at the University of Nigeria Medical Centre. Methods: The study had a prospective cross-sectional design in which malaria status and blood groups and genotype were determined. All collected data were analysed using Statistical product and services Solution (V.21). Frequencies and percentages were used to describe the data while Chi-square and Pearson correlation were used to determine associations between malaria prevalence and patients’ demographic and clinical characteristics. Statistical significance was considered for p<0.05. Results: Three hundred and twenty-three (323) patients were tested for malaria, 245(75.9%) of whom tested positive. The prevalence was highest for patient’s aged 19-25 y (28.5%). The difference was statistically significant for age: χ2 (5) = 33.60, p = 0.0005. There were more blood group O (57.6%) among the patients, while AA genotype was the majority (72.4%). Those with blood group O had the highest prevalence of malaria (33.7%) and it was statistically significant (χ2 (3) = 72.10, p = 0.0005)). Correlation showed that the association between blood group and malaria prevalence was moderate (R = 0.457). The AA genotype had more incidence of malaria (54.5%), but the difference was not statistically significant. Conclusion: The prevalence of malaria was high among the patients surveyed. Its association with the patients’ ABO blood group was established to be statistically significant, with blood group O having the highest incidence. Although AA genotype was observed to have the highest cases of malaria, the relationship was found not to be significant.

scholarly journals Short-Term Prognosis of Transient Ischemic Attack and Predictive Value of the ABCD2 Score in Hong Kong Chinese

2014 ◽  
Vol 4 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Lai Hong Simon Chiu ◽  
Wah Hon Yau ◽  
Ling Pong Leung ◽  
Peter Pang ◽  
Chee Tat Tsui ◽  
...  
Keyword(s):  
Hong Kong ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Hong Kong Chinese ◽  
Short Term ◽  
Abcd2 Score ◽  
Ischemic Attack

scholarly journals High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack

2016 ◽  
Vol 6 (3) ◽  
pp. 76-83 ◽  
Author(s):  
Shawna Cutting ◽  
Elizabeth Regan ◽  
Vivien H. Lee ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Heart Association ◽  
Reperfusion Therapy ◽  
Large Artery ◽  
Increased Risk ◽  
Risk Patients ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Ischemic Events

Background and Purpose: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. Methods: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h. Three interventions were prespecified: anticoagulation for atrial fibrillation, carotid or intracranial revascularization, and intravenous or intra-arterial reperfusion therapies. We compared rates of in-hospital recurrent TIA or ischemic stroke and the receipt of interventions among patients with low (<3) versus high (≥3) ABCD2 scores. Results: Of 249 patients, 11 patients (4.4%) had recurrent TIAs or strokes during their stay (8 TIAs, 3 strokes). All 11 had ABCD2 scores ≥3, and no neurological events occurred in patients with lower scores (5.1 vs. 0%; p = 0.37). Twelve patients (4.8%) underwent revascularization for large artery stenosis, 16 (6.4%) were started on anticoagulants, and no patient received intravenous or intra-arterial reperfusion therapy. The ABCD2 score was not associated with anticoagulation (p = 0.59) or revascularization (p = 0.20). Conclusions: Higher ABCD2 scores may predict early ischemic events after TIA but do not predict the need for intervention. Outpatient evaluation for those with scores <3 would potentially have delayed revascularization or anticoagulant treatment in nearly one-fifth of ‘low-risk' patients.

scholarly journals An Assessment of the Incremental Value of the ABCD2 Score in the Emergency Department Evaluation of Transient Ischemic Attack

2011 ◽  
Vol 57 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Latha G. Stead ◽  
Smitha Suravaram ◽  
M. Fernanda Bellolio ◽  
Sailaja Enduri ◽  
Alejandro Rabinstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Transient Ischemic Attack ◽  
Incremental Value ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Department Evaluation

scholarly journals CASE REPORT: STROKE PREDICTION MODELS AFTER TRANSIENT ISCHEMIC ATTACK WITH ATRIAL FIBRILLATION

2019 ◽  
Vol 2 (2) ◽  
pp. 70-73
Author(s):  
Mason Rubianto ◽  
Samudra Andi Yusuf ◽  
Stefano Giovani
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Transient Ischemic Attack ◽  
Prediction Models ◽  
Stroke Recurrence ◽  
Nervus Facialis ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Stage 1

Background : Atrial fibrillation (AF) is an independent risk factor for stroke. The role of AF in transient ischemic attack (TIA) is less common. Thus, this situation cannot be underestimated because both TIA and AF are increasing the risk of a patient to get stroke. Case : An 80 years old woman presented with speech disturbance and disorientation which lasted for 2 hours. Patients look confused with glasgow coma scale total 13 (E4V3M6), blood pressure was 150/80 and heart rate 147 beats/min irregular. From neurological examination, there was paresis nervus facialis central and nervus hypoglossus but completely resolved under 24 hours. Her electrocardiogram showed an AF. Working diagnosis for this patient were TIA with AF and hypertension stage 1. Discussion : The early risk of stroke seems to be best predicted with ABCD2 score, which is calculated by summing up points for five independent factors: (1) age, (2) blood pressure, (3) clinical features of TIA, (4) duration of TIA and (5) diabetes. The ABCD2 score of this patient is 5 which classified as moderate risk. Conclusion : These patients require a comprehensive approach and additional an imaging consideration because there are a moderate to higher chance of stroke recurrence. Keywords : Atrial Fibrillation, ABCD2 Score, Stroke, Transient Ischemic Attack

scholarly journals ABCD2 score to identify individuals on admission at high early risk of stroke after transient ischemic attack

Nosotchu ◽  
2011 ◽  
Vol 33 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Mayumi Mori ◽  
Yasushi Okada ◽  
Sohei Yoshimura ◽  
Tomonaga Matsushita ◽  
Yuichi Miyazaki ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Early Risk ◽  
Abcd2 Score ◽  
Ischemic Attack

Abstract 149: Evaluating the Risk of Cerebrovascular Events Among Those Seeking Information on Transient Ischemic Attack Symptoms on the Internet

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Anthony S Kim ◽  
Sharon N Poisson ◽  
J. Donald Easton ◽  
S. Claiborne Johnston
Keyword(s):  
Transient Ischemic Attack ◽  
Medical Information ◽  
Medical Attention ◽  
The Internet ◽  
Cerebrovascular Event ◽  
C Statistic ◽  
Cerebrovascular Events ◽  
Abcd2 Score ◽  
Ischemic Attack

Background: Despite the high risk of stroke after transient ischemic attack (TIA), many people do not seek urgent medical attention because symptoms may be mild or have already resolved or be incorrectly attributed to a benign mimic. Since the Internet has become an increasingly important source of medical information, we sought to reach these people by developing and testing an instrument to identify cerebrovascular events among those seeking information about TIA online. Methods: We developed an instrument to evaluate possible TIA symptoms ( http://tia.ucsf.edu/ ) using items from the ABCD2 score excluding blood pressure since it may not be readily available by self-report. Using targeted Internet text advertisements for terms such as “transient ischemic attack symptoms” or “mini-stroke symptoms” we invited subjects to complete a 20-item demographic, medical history, and symptom inventory online. Neurologists that were blinded to these responses then contacted subjects by telephone to assess the likelihood that a true TIA or stroke had occurred. Logistic regression was used to assess univariate and multivariable associations and ROC curves were generated to assess model discrimination. Results: The study website received 26,602 hits over 122 days of study enrollment. A total of 289 visitors started the enrollment and eligibility screening process, 253 provided consent and recorded responses for the instrument, and 173 completed the follow-up telephone assessment. The mean age was 58.7 years (range 23-88) and 63% were women. A total of 36 (21%) subjects had had symptoms within 24 hours and 60 (37%) had not yet sought medical advice for their symptoms. The follow-up telephone assessment process determined that 43 (24.9%) had a TIA, and 67 (38.7%) had either a TIA or a stroke. The ABCD2 score (excluding blood pressure) demonstrated moderate discrimination overall (c-statistic 0.69, 95% CI 0.61-0.76), but 1 (8.3%) of 12 subjects with a score of 0 had a cerebrovascular event (isolated diplopia). Those who reported multiple prior episodes of similar symptoms in the past year were less likely to have had a cerebrovascular event (OR 0.18, 95% CI 0.10-0.37) and incorporating this predictor and the presence of diplopia into the model significantly improved discrimination (c-statistic 0.78, 95% CI 0.71-0.85, p=0.03) with no events among the 7 patients who had a score of 0. Conclusion: Patients with possible TIA symptoms turn to the Internet for medical information and prior to any attempt to seek formal medical advice. Although applying self-reported elements of the ABCD2 score was inadequate to rule-out cerebrovascular disease, a modified score with additional elements may provide an efficient, immediate, and individualized mechanism to reach patients with TIA who might not otherwise seek medical attention.

Long-Term Risk of Stroke after Transient Ischemic Attack

2016 ◽  
Vol 43 (1-2) ◽  
pp. 25-30 ◽  
Author(s):  
Peter Appelros ◽  
Maria Háls Berglund ◽  
Jakob O. Ström
Keyword(s):  
Risk Factors ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Significant Risk ◽  
Active Management ◽  
Speech Impairment ◽  
Operating Characteristics ◽  
Abcd2 Score ◽  
Ischemic Attack

Background: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context. Methods: Riksstroke is the national stroke registry in Sweden. Data from Riksstroke's TIA module, and the national cause-of-death register, for the years 2011 and 2012 were used in this study. Stroke occurrence was monitored via Riksstroke. Cox's regression was used for risk evaluation. The predictive value of the ABCD2 score was assessed by calculating the area under the receiver operating characteristics curve. Results: A total of 15,068 TIA episodes occurred in 14,102 patients. The follow-up time varied between 0 and 819 days, with an average of 417 days. The mortality for all TIA patients during the follow-up time was 7.1%. Of the unique patients, 545 had one or more strokes (3.9%), corresponding to 34 events per 1,000 person years. Significant risk factors for stroke were: age, previous TIA, atrial fibrillation (AF), oral anticoagulant (OAC) treatment, hypertension treatment, and the ABCD2 items speech impairment, unilateral weakness, and diabetes mellitus. The ABCD2 score correlated with a subsequent stroke, but its predictive value was low. Conclusion: The risk of stroke is low after the acute phase of a TIA, probably lower than in previous studies. This may be due to better secondary prevention in recent years. Several risk factors predict stroke, notably hypertensive treatment, which may be inadequate; and AF, where OACs may be under-used. It is difficult to identify the role of the ABCD2 score in clinical practice.

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