Is the evaluation and treatment of transient ischemic attack performed according to current knowledge? A nationwide Israeli registry.

KeY words: a cute stroke is a medical emergency. With the introduction of acute thrombolytic therapy, it is essential that patients with relevant symptoms arrive as soon as possible to medical facilities for prompt diagnosis and treatment. Transient ischemic attacks, however, are short lived and were believed to carry a better prognosis, thus more time for their evaluation and initiation of treatment was allowed. Recently, however, with documented early stroke occurrence of up to 8% within a week [1] and up to 20% within 3 months after the event [2,3], TIA1 has become an urgent situation as well. Several scales and methods have been developed to identify patients who carry the highest risks. The most popular is the ABCD2 scale [3] which has five factors with seven points. Using this clinical scale Johnston et al. [3] found a very high early risk of recurrence (8.1% at 2 days) among patients with a score of 6 or 7 points [3]. Other important factors were also identified, including the underlying etiology, mainly the presence of large artery disease [4-6], and specific radiological findings [7-11]. Brain imaging (computed tomography or magnetic resonance imaging) in which previous or recent infarcts were demonstrated were found to be associated with high early risks. This led to the development of new composite scales. By adding the emergency room CT or MRI findings to the ABCD2 score, the ability to identify those patients with the highest risks was augmented, as shown by the ABCD2I and the ABCD3-I scales [12,13]. The former includes brain findings (another 1 to 3 points), and the latter includes, in addition to the brain findings, a history of recent TIA and imaging for (significant) carotid stenosis with a total score of 13 points. The importance of intracranial stenosis was also demonstrated [11]. Options to reduce this high risk include prompt admission of patients to hospital for early investigation and treatment [14], and immediate administration of intensive medical treatment (antithrombotic, antihypertensive and statin), which TIA = transient ischemic attack