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Emergencies in Neurology pp 189–214Cite as

Risk Stratification and Management of TIA and Minor Stroke

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Abstract

Together, transient ischemic attack (TIA) and minor stroke represent the largest group of cerebrovascular events, with one study estimating that over 80% of all stroke patients fall into this category [1]. With the advent of reperfusion therapies for acute ischemic stroke, systems of care have been streamlined such that patients with disabling or non-disabling deficits often present and are assessed very quickly after the onset of symptoms. Despite this, those with non-disabling deficits often fall into a therapeutic void since they are not considered eligible for thrombolysis or thrombectomy. This is particularly tragic since among patients considered too mild for thrombolytic therapy, up to one-third end up dead or dependent on being discharged from hospital [2, 3]. Furthermore, 15–30% of disabling strokes are heralded by non-disabling stroke or TIA, usually within the preceding 7 days [4]. Many studies have also demonstrated that after TIA or minor stroke, there is an approximately 10% risk of subsequent stroke within 90 days [5–13]. Functional disability may also affect about 15% of patients with TIA and minor stroke even in the absence of stroke recurrence [14]. Finally, as markers of vascular disease, TIAs predict an increased risk for all cardiovascular events and death in the longer term [5, 8]. Patients with mild cerebral ischemia represent an ideal target for therapy since they have a significant amount of tissue and function to safeguard in the face of an elevated early risk of major stroke.

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Authors and Affiliations

  1. Department of Neurosciences, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Université de Montréal, Montreal, QC, Canada

    Alexandra D. Muccilli & Alexandre Y. Poppe

  2. Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    Shelagh B. Coutts & Andrew M. Demchuk

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  1. Alexandra D. Muccilli
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  2. Shelagh B. Coutts
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  3. Andrew M. Demchuk
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  4. Alexandre Y. Poppe
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Correspondence to Alexandra D. Muccilli .

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  1. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Mamta Bhushan Singh

  2. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Rohit Bhatia

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Muccilli, A.D., Coutts, S.B., Demchuk, A.M., Poppe, A.Y. (2019). Risk Stratification and Management of TIA and Minor Stroke. In: Singh, M., Bhatia, R. (eds) Emergencies in Neurology . Springer, Singapore. https://doi.org/10.1007/978-981-13-5866-1_10

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