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Neurology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
This gives a total score ranging from 0 to 7. People who have had a suspected TIA who are at a higher risk of stroke (that is, with an ABCD2 score of 4 or above) should have: aspirin (300 mg daily) started immediatelyspecialist assessment and investigation within 24 hours of onset of symptomsmeasures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors
Stroke and TIA
Published in Anita Sharma, Shauna Dixon, Tanya Claridge, Maximising Quality and Outcomes Framework Quality Points, 2017
Anita Sharma, Shauna Dixon, Tanya Claridge
Those patients with an ABCD2 score > 4 are classified as ‘high risk’ and should have a specialist assessment and investigations within 24 hours. The patients with a score of < 4 are classified as ‘low risk’ and should have specialist assessment and investigation within one week.
Transient ischaemic attacks
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
TIA has long been identified as a strong marker of vascular risk. Up to 40% of patients presenting with stroke give a history consistent with prior TIA, the majority occurring in the days or weeks before the stroke occurred. Prompt identification, risk stratification, and treatment of patients presenting with TIA is therefore advantageous. In recent years, a number of studies have sought to identify which TIA patients are at particularly high risk of stroke. Use of a simple risk stratification score (the ABCD2 score) has been shown to predict short-term risk of stroke in TIA patients using easily measured clinical parameters. Patients presenting with TIA score points for each of the following factors:
Morphology and histology of silent and symptom-causing atherosclerotic carotid plaques – Rationale and design of the Helsinki Carotid Endarterectomy Study 2 (the HeCES2)
Published in Annals of Medicine, 2018
Krista Nuotio, Petra Ijäs, Hanna M. Heikkilä, Suvi M. Koskinen, Jani Saksi, Pirkka Vikatmaa, Pia Sorto, Laura Mäkitie, Henrietta Eriksson, Sonja Kasari, Heli Silvennoinen, Leena Valanne, Mikko I. Mäyränpää, Petri T. Kovanen, Lauri Soinne, Perttu J. Lindsberg
CEA patients occasionally had other potential aetiologies (e.g. atrial fibrillation or small vessel disease) for the clinical symptom in addition to the carotid atherosclerosis. Two neurologists (K.N., P.I.) independently evaluated if a patient had experienced a genuine ischaemic cerebrovascular symptom (defined as symptomatic patient), as well as whether the operated CP had caused the thromboembolic symptoms (defined as symptom-causing plaque). This was performed in each case by recording all possible major and minor aetiologies, and considering thoroughly the situation of symptom presentation, collateral status of cerebral circulation as well as location and extent of the putative cerebral ischemia. If the symptom was assumed to be caused by hemodynamic mechanism rather than thromboembolism, the symptom status was defined as ambiguous. In case of ambiguity regarding the symptom status of the plaque or between competing aetiologies, a panel of stroke neurologists (P.I., K.N., L.S. and P.J.L.) was consulted to reach a consensus. The diagnoses and plaque status were determined blinded to macroscopic evaluation of plaques. Subtypes of ischemic stroke were recorded according to the TOAST classification [23], and the stroke risk after TIAs was classified by the ABCD2 prognostic score [24].
When are the cardiovascular and stroke risks too high? Pharmacotherapy for stroke prophylaxis
Published in Expert Opinion on Pharmacotherapy, 2018
Antonio Gómez-Outes, Mª Luisa Suárez-Gea, Jose Manuel García-Pinilla
The ABCD2 score is a risk assessment tool designed to improve the prediction of short-term stroke risk after a TIA [24]. It was validated in four independent groups of patients (n = 2893) diagnosed with TIA in emergency departments and clinics in defined populations in the United States (US) and UK. It is based on five parameters (age, blood pressure, clinical features, duration of TIA, and presence of diabetes). Scores for each item are added together to produce an overall result ranging between 0 and 7. Higher ABCD2 scores are associated with greater risk of stroke. For those patients with an ABCD2 score >3, hospital observation and evaluation is recommended [24].