Clinical and Imaging Features of Transient Ischaemic Attack and the Utility of ABCD2 Score.

Karthik, S N (2010) Clinical and Imaging Features of Transient Ischaemic Attack and the Utility of ABCD2 Score. Masters thesis, Madras Medical College, Chennai.


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Cerebrovascular disease is the third leading cause of death in developed countries after heart disease and cancer; the overall prevalence is 794 per 100,000. It is estimated that more than 700,000 patients have a stroke each year in the United States. The loss of these patients from the work force and the extended hospitalization they require during recovery make the economic impact of the disease one of the most devastating in medicine. About 15-20% of patients with stroke have a preceding TIA, making it one of the common neurologic problems. Four to 20 percent of patients who have a TIA, experience a stroke within the following 90 days; one half of those strokes occur within 48 hours. Promptly recognizing patients who are at high risk of progressing to stroke provide us a golden opportunity for stroke prevention. This depends upon accurately identifying the cause of symptoms, and the nature, location, and severity of causative cardiac, hematologic, and cerebrovascular abnormalities. TIA being a clinical diagnosis, there is a significant variation among physicians and neurologists in diagnosing this condition. In one series, majority (81%) of the TIA referrals from general practitioners to neurology clinics were for nonvascular events. Even the percent agreement among two neurologists for the diagnosis of TIA by history varies from 42% to 86%. In such a situation development of a scoring system like ABCD2, not only helps in triaging the patients but also acts as a tool in diagnosing and further assessing these patients. Although there are studies regarding stroke, currently there are no big studies from India regarding the clinical and imaging features in patients with TIA. Also ABCD2 score as a tool is not being routinely used even by the Neurologist. Considering the limited information available from India, this study was undertaken to determine the utility of ABCD2 scoring system in Indian population and to determine the differences in risk factors and clinical profile if any, when compared to western population. The maximum number of patients were in the age group between 50 and 59 years. (35.92%). Compared to western population, TIA in our study population occurred a decade earlier. TIAs occurred more frequently in males (56.3%) than in females (43.7%) showing a general male preponderance of the disease. Males predominated in the age group between 40 and 59 years (70.7%), while females predominated in the age group between 50 and 69 years (61.1%) indicating that females developed TIA at a later age compared to males. Common risk factors were hypertension (62.6%), hyperlipidemia (40.7%), diabetes mellitus (44.6%), smoking (45.1%) and alcoholism (35.4%). Modification of lifestyle and proper management of these modifiable risk factors might play a major role in the primary and secondary prevention of ischemic stroke. Motor weakness was the commonest clinical presentation and was seen in 65.53% in this study. Speech disturbance was the next common symptom seen in 40.77% (aphasia constituted 16.2% and dysarthria 24.57%). • There was no significant difference between the proportion of patients with short duration (< 60 min, 102 patients) and long duration (> 60 min, 104 patients) TIAs in our study. • Our study showed an association between AF and 5 clinical features: (1) age ≥ 60 years, (2) consciousness disturbance, (3) nausea and vomiting, (4) dizziness/vertigo and (5) gait disturbance during TIA. Consciousness disturbance and gait disturbance were more frequent in AF group than in non-AF group. • 22.2% of patients without prior history of stroke had positive CT imaging after TIA. • There was no significant difference in duration of TIA between the CT positive and CT negative group. • There was a significant association between older age, hypertension and Carotid stenosis (>50%) and presence of infarct in CT. • Infarction prevalence was slightly higher in carotid than vertebrobasilar patients (23.3% and 21.5%) but it was not statistically significant. • According to ABCD2 score 62 (30.1%) patients were in low risk group, 84 (40.8%) in moderate risk, while 60 (29.1%) were in high risk group in our study. • The proportion of patients with a score of 7 (14.5%) was higher in our study. • The overall risk of developing stroke at 2 days, 7 days and 90 days were 5.3%, 9.2% and 11.6% respectively in our study. The risk at the end of 30 days was same as 7 day risk. • Patients with score between 0 and 3 did not develop stoke within 90 days. And there was no mortality within 90 days in our study. • Administration of heparin did not significantly alter the development of stroke at 7 days in high risk group.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Transient Ischaemic Attack; Utility of ABCD2 Score ; Clinical and Imaging Features.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 28 Jun 2017 11:38
Last Modified: 28 Jun 2017 11:38

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