[Guideline] Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurolo... Stroke. 2009 Jun. 40(6):2276-93. [QxMD MEDLINE Link].
Dhamoon MS, Sciacca RR, Rundek T, Sacco RL, Elkind MS. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006 Mar 14. 66 (5):641-6. [QxMD MEDLINE Link].
Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007 Dec. 6(12):1063-72. [QxMD MEDLINE Link].
[Guideline] National Institute for Health and Clinical Excellence (NICE) Stroke Guidelines. Available at http://guidance.nice.org.uk/CG68/Guidance/pdf/English. Accessed: September 22, 2010.
Jacobs BS, Birbeck G, Mullard AJ, Hickenbottom S, Kothari R, Roberts S, et al. Quality of hospital care in African American and white patients with ischemic stroke and TIA. Neurology. 2006 Mar 28. 66(6):809-14. [QxMD MEDLINE Link].
White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation. 2005 Mar 15. 111(10):1327-31. [QxMD MEDLINE Link]. [Full Text].
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, et al. Transient ischemic attack--proposal for a new definition. N Engl J Med. 2002 Nov 21. 347(21):1713-6. [QxMD MEDLINE Link]. [Full Text].
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27. 369(9558):283-92. [QxMD MEDLINE Link].
Kleindorfer D, Panagos P, Pancioli A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke. 2005 Apr. 36(4):720-3. [QxMD MEDLINE Link]. [Full Text].
Johnston SC, Fayad PB, Gorelick PB, Hanley DF, Shwayder P, van Husen D, et al. Prevalence and knowledge of transient ischemic attack among US adults. Neurology. 2003 May 13. 60(9):1429-34. [QxMD MEDLINE Link].
Edlow JA, Kim S, Pelletier AJ, Camargo CA Jr. National study on emergency department visits for transient ischemic attack, 1992-2001. Acad Emerg Med. 2006 Jun. 13(6):666-72. [QxMD MEDLINE Link].
Truelsen T, Begg S, Mathers C. World Health Organization. The global burden of cerebrovascular disease. Global Burden of Disease 2000. Available at http://www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestroke.pdf. Accessed: July 9, 2013.
Bots ML, van der Wilk EC, Koudstaal PJ, Hofman A, Grobbee DE. Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance. Stroke. 1997 Apr. 28(4):768-73. [QxMD MEDLINE Link]. [Full Text].
Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007 Dec 10. 167(22):2417-22. [QxMD MEDLINE Link].
Amarenco P, Goldstein LB, Sillesen H, Benavente O, Zweifler RM, Callahan A 3rd, et al. Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2010 Mar. 41(3):426-30. [QxMD MEDLINE Link].
Chandratheva A, Lasserson DS, Geraghty OC, Rothwell PM. Population-based study of behavior immediately after transient ischemic attack and minor stroke in 1000 consecutive patients: lessons for public education. Stroke. 2010 Jun. 41(6):1108-14. [QxMD MEDLINE Link]. [Full Text].
Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: a population-based case-control study. Stroke. 2001 May. 32(5):1054-60. [QxMD MEDLINE Link].
Smith WS, Johnston SC, Skalabrin EJ, Weaver M, Azari P, Albers GW, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology. 2003 May 13. 60(9):1424-8. [QxMD MEDLINE Link].
Bos MJ, van Rijn MJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM. Incidence and prognosis of transient neurological attacks. JAMA. 2007 Dec 26. 298(24):2877-85. [QxMD MEDLINE Link]. [Full Text].
Redgrave JN, Schulz UG, Briley D, Meagher T, Rothwell PM. Presence of acute ischaemic lesions on diffusion-weighted imaging is associated with clinical predictors of early risk of stroke after transient ischaemic attack. Cerebrovasc Dis. 2007. 24(1):86-90. [QxMD MEDLINE Link].
Prabhakaran S, Chong JY, Sacco RL. Impact of abnormal diffusion-weighted imaging results on short-term outcome following transient ischemic attack. Arch Neurol. 2007 Aug. 64(8):1105-9. [QxMD MEDLINE Link].
Ay H, Koroshetz WJ, Benner T, Vangel MG, Wu O, Schwamm LH, et al. Transient ischemic attack with infarction: a unique syndrome?. Ann Neurol. 2005 May. 57(5):679-86. [QxMD MEDLINE Link]. [Full Text].
Asimos AW, Rosamond WD, Johnson AM, Price MF, Rose KM, Murphy CV, et al. Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients. Stroke. 2009 Oct. 40(10):3252-7. [QxMD MEDLINE Link].
Giles MF, Albers GW, Amarenco P, Arsava EM, Asimos AW, Ay H, et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: A multicenter study. Neurology. 2011 Sep 27. 77(13):1222-8. [QxMD MEDLINE Link]. [Full Text].
Bray JE, Coughlan K, Bladin C. Can the ABCD Score be dichotomised to identify high-risk patients with transient ischaemic attack in the emergency department?. Emerg Med J. 2007 Feb. 24(2):92-5. [QxMD MEDLINE Link]. [Full Text].
Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA, et al. National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol. 2006 Sep. 60(3):301-13. [QxMD MEDLINE Link]. [Full Text].
Sheehan OC, Merwick A, Kelly LA, Hannon N, Marnane M, Kyne L, et al. Diagnostic usefulness of the ABCD2 score to distinguish transient ischemic attack and minor ischemic stroke from noncerebrovascular events: the North Dublin TIA Study. Stroke. 2009 Nov. 40(11):3449-54. [QxMD MEDLINE Link].
Tsivgoulis G, Stamboulis E, Sharma VK, Heliopoulos I, Voumvourakis K, Teoh HL, et al. Multicenter external validation of the ABCD2 score in triaging TIA patients. Neurology. 2010 Apr 27. 74(17):1351-7. [QxMD MEDLINE Link]. [Full Text].
Asimos AW, Johnson AM, Rosamond WD, et al. A multicenter evaluation of the ABCD2 score's accuracy for predicting early ischemic stroke in admitted patients with transient ischemic attack. Ann Emerg Med. 2010 Feb. 55(2):201-210.e5. [QxMD MEDLINE Link]. [Full Text].
Chandratheva A, Geraghty OC, Luengo-Fernandez R, Rothwell PM. ABCD2 score predicts severity rather than risk of early recurrent events after transient ischemic attack. Stroke. 2010 May. 41(5):851-6. [QxMD MEDLINE Link]. [Full Text].
Stead LG, Suravaram S, Bellolio MF, Enduri S, Rabinstein A, Gilmore RM, et al. An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack. Ann Emerg Med. 2011 Jan. 57(1):46-51. [QxMD MEDLINE Link].
Fothergill A, Christianson TJ, Brown RD Jr, Rabinstein AA. Validation and refinement of the ABCD2 score: a population-based analysis. Stroke. 2009 Aug. 40(8):2669-73. [QxMD MEDLINE Link]. [Full Text].
Amarenco P, Labreuche J, Lavallée PC, Meseguer E, Cabrejo L, Slaoui T, et al. Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack?. Stroke. 2009 Sep. 40(9):3091-5. [QxMD MEDLINE Link].
Merwick A, Albers GW, Amarenco P, Arsava EM, Ay H, Calvet D, et al. Addition of brain and carotid imaging to the ABCD² score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study. Lancet Neurol. 2010 Nov. 9(11):1060-9. [QxMD MEDLINE Link].
Schwamm LH, Pancioli A, Acker JE 3rd, Goldstein LB, et al. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association's Task Force on the Development of Stroke Systems. Stroke. 2005 Mar. 36(3):690-703. [QxMD MEDLINE Link].
Donnan GA, Davis SM, Hill MD, Gladstone DJ. Patients with transient ischemic attack or minor stroke should be admitted to hospital: for. Stroke. 2006 Apr. 37(4):1137-8. [QxMD MEDLINE Link].
Lindley RI. Patients with transient ischemic attack do not need to be admitted to hospital for urgent evaluation and treatment: against. Stroke. 2006 Apr. 37(4):1139-40. [QxMD MEDLINE Link].
Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007 Oct 20. 370(9596):1432-42. [QxMD MEDLINE Link].
Wu CM, Manns BJ, Hill MD, Ghali WA, Donaldson C, Buchan AM. Rapid evaluation after high-risk TIA is associated with lower stroke risk. Can J Neurol Sci. 2009 Jul. 36(4):450-5. [QxMD MEDLINE Link].
Torres Macho J, Peña Lillo G, Pérez Martínez D, González Mansilla A, Gámez Díez S, Mateo Alvarez S, et al. Outcomes of atherothrombotic transient ischemic attack and minor stroke in an emergency department: results of an outpatient management program. Ann Emerg Med. 2011 May. 57(5):510-6. [QxMD MEDLINE Link].
Lavallée PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007 Nov. 6(11):953-60. [QxMD MEDLINE Link].
Giles MF, Rothwell PM. Substantial underestimation of the need for outpatient services for TIA and minor stroke. Age Ageing. 2007 Nov. 36(6):676-80. [QxMD MEDLINE Link].
Ross MA, Compton S, Medado P, Fitzgerald M, Kilanowski P, O'Neil BJ. An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial. Ann Emerg Med. 2007 Aug. 50(2):109-19. [QxMD MEDLINE Link].
Adams HP Jr, Adams RJ, Brott T,et al. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003 Apr. 34(4):1056-83. [QxMD MEDLINE Link].
Sacco RL, Adams R, Albers G, Alberts MJ, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Feb. 37(2):577-617. [QxMD MEDLINE Link].
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, American Heart Association Stroke Council, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Jul. 45 (7):2160-236. [QxMD MEDLINE Link].
Wintzer-Wehekind J, Alperi A, Houde C, Côté JM, Asmarats L, Côté M, et al. Long-Term Follow-Up After Closure of Patent Foramen Ovale in Patients With Cryptogenic Embolism. J Am Coll Cardiol. 2019 Jan 29. 73 (3):278-287. [QxMD MEDLINE Link].
Hughes S. PFO Closure After Stroke Shows Long-term Benefits. Medscape Medical News. Available at https://www.medscape.com/viewarticle/908349. 2019 Jan 29; Accessed: January 30, 2019.
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011 Sep 15. 365(11):993-1003. [QxMD MEDLINE Link]. [Full Text].
Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007 Oct 20. 370(9596):1432-42. [QxMD MEDLINE Link].
Halliday AW, Lees T, Kamugasha D, et al. Waiting times for carotid endarterectomy in UK: observational study. BMJ. 2009 Jun 4. 338:b1847. [QxMD MEDLINE Link]. [Full Text].
Gladstone DJ, Oh J, Fang J, Lindsay P, Tu JV, Silver FL, et al. Urgency of carotid endarterectomy for secondary stroke prevention: results from the Registry of the Canadian Stroke Network. Stroke. 2009 Aug. 40(8):2776-82. [QxMD MEDLINE Link].
Hughes S. CT Flags TIA Patients at High Stroke Risk. Medscape Medical News. Dec 5 2014. [Full Text].
Wasserman JK, Perry JJ, Sivilotti ML, et al. Computed Tomography Identifies Patients at High Risk for Stroke After Transient Ischemic Attack/Nondisabling Stroke: Prospective, Multicenter Cohort Study. Stroke. 2014 Dec 4. [QxMD MEDLINE Link].
[Guideline] Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011 Jan. 42(1):227-76. [QxMD MEDLINE Link].
Anderson P. Short Course of Aspirin, Clopidogrel Cuts Stroke Risk. Medscape Medical News. February 11, 2013. Available at http://www.medscape.com/viewarticle/779089. Accessed: February 25, 2013.

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Table 1. National Institutes of Health Stroke Scale

	Category	Score - Description
1a	level of consciousness (LOC)	0 Alert 1 Drowsy 2 Stuporous 3 Coma
1b	LOC questions (month, age)	0 Answers both correctly 1 Answers 1 correctly 2 Incorrect on both
1c	LOC commands (open and close eyes, grip and release nonparetic hand)	0 Obeys both correctly 1 Obeys 1 correctly 2 Incorrect on both
2	Best gaze (follow finger)	0 Normal 1 Partial gaze palsy 2 Forced deviation
3	Best visual (visual fields)	0 No visual loss 1 Partial hemianopia 2 Complete hemianopia 3 Bilateral hemianopia
4	Facial palsy (show teeth, raise brows, squeeze eyes shut)	0 Normal 1 Minor 2 Partial 3 Complete
5	Motor arm left* (raise 90°, hold 10 seconds)	0 No drift 1 Drift 2 Cannot resist gravity 3 No effort against gravity 4 No movement
6	Motor arm right* (raise 90°, hold 10 seconds)	0 No drift 1 Drift 2 Cannot resist gravity 3 No effort against gravity 4 No movement
7	Motor leg left* (raise 30°, hold 5 seconds)	0 No drift 1 Drift 2 Cannot resist gravity 3 No effort against gravity 4 No movement
8	Motor leg right* (raise 30°, hold 5 seconds)	0 No drift 1 Drift 2 Cannot resist gravity 3 No effort against gravity 4 No movement
9	Limb ataxia (finger-nose, heel-shin)	0 Absent 1 Present in 1 limb 2 Present in 2 limbs
10	Sensory (pinprick to face, arm, leg)	0 Normal 1 Partial loss 2 Severe loss
11	Extinction/neglect (double simultaneous testing)	0 No neglect 1 Partial neglect 2 Complete neglect
12	Dysarthria (speech clarity to “mama, baseball, huckleberry, tip-top, fifty-fifty”)	0 Normal articulation 1 Mild to moderate dysarthria 2 Near to unintelligible or worse
13	Best language** (name items, describe pictures)	0 No aphasia 1 Mild to moderate aphasia 2 Severe aphasia 3 Mute
	Total	0-42
* For limbs with amputation, joint fusion, etc, score 9 and explain. ** For intubation or other physical barriers to speech, score 9 and explain. Do not add 9 to the total score

Table 2. ABCD ² Score

A: Age ≥60 years	1 point
B : Blood pressure: Systolic ≥140 mm Hg or diastolic ≥90 mm Hg	1 point
C: Clinical features
Unilateral weakness with or without speech impairment	2 points
Speech impairment without unilateral weakness	1 point
D: Duration
≥60 min	2 points
10-59 min	1 point
D: Diabetes	1 point
Total	0-7 points

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Author

Ashish Nanda, MD Assistant Professor of Neurology, Neurosurgery and Radiology, Stroke and Neurointerventional, Department of Neurology and Neurosurgery, Co-Director of Missouri Stroke Program, University of Missouri-Columbia School of Medicine

Ashish Nanda, MD is a member of the following medical societies: American Stroke Association, Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Chief Editor

Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center

Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Peter MC DeBlieux, MD Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Joshua N Goldstein, MD, PhD, FAAEM Assistant Professor, Harvard Medical School; Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital

Joshua N Goldstein, MD, PhD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Neurocritical Care Society, and Society for Academic Emergency Medicine

Disclosure: CSL Behring Consulting fee Consulting

Lauren M Nentwich, MD Attending Physician, Department of Emergency Medicine, Boston Medical Center; Instructor, Department of Emergency Medicine, Boston University School of Medicine

Lauren M Nentwich is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, Massachusetts Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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