Researchers Release Clinical Update on Transient Ischemic Attacks

Shuhan Zhu, MD, is a fourth year neurology resident who authored the expert commentary.
Shuhan Zhu, MD, is a fourth year neurology resident who authored the expert commentary.

BUSM researchers have released a guide to help primary care doctors navigate the new May 2014 American Heart Association/American Stroke Association guidelines on transient ischemic attacks (TIA).

TIA’s, commonly known as “mini-strokes” can be the first and only warning sign of a larger, debilitating stroke to come. The most common symptoms are temporary weakness on one side or speech disturbance. These ostensibly minor symptoms often prompt patients to see their primary care doctor instead of presenting to an emergency room or neurology clinic. This expert commentary, authored by Shuhan Zhu, MD, fourth year neurology resident, and Michael Perloff, MD, PhD, assistant professor of neurology at BUSM, offers insight into how primary care doctors can properly and expeditiously manage this complex and serious medical condition. The summary and recommendations appear in ┬áthe American Journal of Medicine

This article includes evidence-based, up-to-date information about the shift away from a time-based definition to an ischemic tissue-based approach (reversible tissue damage) in diagnosing TIA, underscoring the increasing importance of brain imaging modalities with CT or MRI in the evaluation of TIA-like symptoms. Primary care doctors are also encouraged to use validated risk calculators like the ABCD2 score to estimate the risk of stroke following a TIA.

The best management, the authors advise, is prevention. They advocate compliance with anti-platelet or anti-coagulation therapy, rigorous management of cardiac risk factors like hypertension and diabetes, as well as lifestyle modification like smoking and alcohol cessation.