Matthew Maximillian Padrick, MD, BA
Dolmans LS, Lebedeva ER, Veluponnar D, van Dijk EJ, Nederkoorn PJ, Hoes AW, et al. Diagnostic Accuracy of the Explicit Diagnostic Criteria for Transient Ischemic Attack: A Validation Study. Stroke. 2019;50:2080–2085
The diagnosis of Transient Ischemic Attack (TIA) has remained one of the murkier diagnoses a physician can encounter, and yet it yields a disproportionately large impact on patient wellbeing. Diagnoses can be given haphazardly, say in a busy emergency department, for brief dizziness, confusion, tingling, or just not feeling quite right. I have seen a patient who was given the diagnosis after less than a minute of isolated whole body shivering. ED neurology consults are a luxury, not the rule, and “follow up with neuro” discharge action plans may never materialize.
With the growing acceptance and implementation of the POINT and CHANCE trials, these TIA diagnoses carry significant weight. Patients with no clear indication may suddenly find themselves on dual antiplatelet therapy, which is certainly not without risk. On the other end of the spectrum, missing the diagnosis significantly increases our patients’ risk of stroke within 6 months. There have been multiple scales created to help with risk stratification, and the quest for reliable biomarkers is well underway.