Transient ischemic attacks (TIA): current issues in diagnosis and management

Transient ischemic attacks (TIAs) affect more than 500,000 Americans each year. Stroke risk approximates 4% to 8% within 1 month and increases to 12% to 13% at one year. This has led to stroke being one of the leading causes of death and disability. TIAs are focal neurologic events that are temporary in nature and warn of potential stroke. Most TIAs resolve within 24 hours. Hypertension, smoking, heart disease, and diabetes are the major risk factors for stroke. A comprehensive history of symptoms can help identify carotid vs. vertebrobasilar disease. Timely evaluation of TIAs should be performed according to recent guidelines set forth by the American Heart Association. Aspirin continues to be the gold standard for stroke prevention, conferring a 48% risk reduction in stroke or death. The use of ticlopidine has been recommended as a second-line agent in patients with aspirin intolerance. Surgical intervention (carotid endarterectomy) is indicated in symptomatic patients with high grade stenosis of 70% or greater. For patients with less significant stenosis, inconclusive data exists regarding the benefit of medical vs. surgical treatment. Patient education should address identification of symptoms, the need for prompt medical attention, and risk factor modification. A collaborative plan between clinician and client will facilitate early intervention ultimately leading to preservation of function and prevention of the catastrophic sequelae of stroke.