Deepak Gulati, MD
Meyer IA, Cereda CW, Correia PN, Zerlauth JP, Puccinelli F, Rotzinger DC, et al. Factors Associated With Focal Computed Tomographic Perfusion Abnormalities in Supratentorial Transient Ischemic Attacks. Stroke. 2017
TIAs are associated with an increased risk of debilitating recurrent stroke along with increased risk for cardiovascular morbidity and mortality. Several studies have demonstrated poor agreement regarding TIA diagnosis among Emergency Department (ED) physicians, neurologists, and even stroke specialists. Although many biomarkers for TIA diagnosis are promising, none has been proven to be sufficiently reliable for diagnosis of TIA. Substantial international variation exists in clinical practice and policies for hospital admission for patients with TIA. International guidelines also differ in their recommendations for brain and vascular imaging after TIA, with imaging either immediately or several days after symptom onset, and brain imaging by either CT or MRI recommended. It has been reported that CTP shows focal perfusion deficits in up to a third of suspected patients with TIA and could also predict functional outcome at 3 months. It has been shown that limiting urgent assessment to patients with a score of 4 or more on ABCD2 would miss approximately 20% of those with early recurrent strokes. There appears to be a need for more research focus on dynamic imaging modalities like CTP or MRP, in addition to clinical information for better diagnosis and management of TIA.