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(Stroke. 2003;34:2451.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Transient Cerebral Ischemia Demands Urgent Evaluation

Department of Emergency Medicine, Southern General Hospital, Glasgow, UK

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Patients suffering a transient ischemic attack (TIA) are at high risk of stroke in the days and weeks following the index event: the risk even at 2 days is more than 5% in studies from the United States¹ and the United Kingdom.²

Johnston and Easton take this concept further and have not only considered those with TIA (as conventionally defined, with no deficit at 24 hours³) but have also examined patients who have had a 50% improvement in NIHSS scores despite a continuing neurological deficit. Their aim was to identify whether the crucial factor in the increased early risk of stroke with TIA is the reversible, labile nature of the neurological deficit, which could be a marker for an underlying unstable atherosclerotic plaque in the cerebral circulation.

The authors utilized the NINDS tPA dataset⁴ to test their hypothesis. One of the exclusion criteria for the NINDS study was "rapidly improving symptoms," so it is likely that a number of patients with TIA who would otherwise have been eligible for NINDS were excluded, which may account for the small number of TIA patients in the study. NINDS was also restricted to those eligible patients for thrombolysis randomization within 3 hours of symptom onset, which again limits the applicability of the results of this study. Many patients with TIA will not present within this time frame,^1,2 but their physicians want to know how aggressive the initial investigation of these patients should be.

The methods used in this study were robust. The . . . [Full Text of this Article]