Transient ischemic attack and minor ischemic stroke

An algorithm for evaluation and treatment

Robert D Jr. Brown, B. A. Evans, D. O. Wiebers, G. W. Petty, Irene Meissner, A. J D Dale

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: To report a cost-effective and scientifically based algorithm for the clinical assessment and treatment of patients with transient ischemic attack (TIA) or minor ischemic stroke. Design: We comprehensively reviewed the literature on the epidemiologic features, assessment approaches, and treatment recommendations for ischemic cerebrovascular disease and developed an algorithm by using the available clinical and research data to support all decision-making steps. Material and Methods: For patients with TIA or minor ischemic stroke, the appropriate setting for investigation (inpatient or outpatient), suggested diagnostic tests, use of anticoagulants and antiplatelet agents, and indications for surgical treatment are reviewed. Results: Although stroke is a common cause of death and lost productivity in the United States, the clinical assessment of patients with TIA or minor ischemic stroke has lacked consistency. The simplified algorithm clarifies patients who may be candidates for hospitalization and possible anticoagulation therapy. Initial diagnostic studies should include computed tomography of the head without use of a contrast agent, which quickly distinguishes nonhemorrhagic from hemorrhagic cerebrovascular disease. Evolving noninvasive studies of the cerebral vasculature are providing increasingly sensitive means of detecting stenoses, yet cerebral angiography remains the 'gold standard.' Treatment options depend on the pathophysiologic findings on diagnostic evaluation. Conclusion: The assessment of patients with ischemic cerebrovascular disease is complex. The simplified algorithmic approach reported herein necessitates entry of appropriate patients into the algorithm. Because of clinical heterogeneity, an algorithm may apply to a wide spectrum of patients but will not cover every situation; hence, evaluation must be guided by a patient's unique history and findings on examination and by the physician's clinical experience.

Original languageEnglish (US)
Pages (from-to)1027-1039
Number of pages13
JournalMayo Clinic Proceedings
Volume69
Issue number11
StatePublished - 1994

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Transient Ischemic Attack
Stroke
Cerebrovascular Disorders
Therapeutics
Cerebral Angiography
Platelet Aggregation Inhibitors
Routine Diagnostic Tests
Anticoagulants
Contrast Media
Inpatients
Cause of Death
Decision Making
Pathologic Constriction
Hospitalization
Outpatients
History
Head
Tomography
Physicians
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Transient ischemic attack and minor ischemic stroke : An algorithm for evaluation and treatment. / Brown, Robert D Jr.; Evans, B. A.; Wiebers, D. O.; Petty, G. W.; Meissner, Irene; Dale, A. J D.

In: Mayo Clinic Proceedings, Vol. 69, No. 11, 1994, p. 1027-1039.

Research output: Contribution to journalArticle

Brown, Robert D Jr. ; Evans, B. A. ; Wiebers, D. O. ; Petty, G. W. ; Meissner, Irene ; Dale, A. J D. / Transient ischemic attack and minor ischemic stroke : An algorithm for evaluation and treatment. In: Mayo Clinic Proceedings. 1994 ; Vol. 69, No. 11. pp. 1027-1039.
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