Summary
Definition
病史和体格检查
关键诊断因素
- patient/caregiver report of focal neurologic deficit
- sudden onset and brief duration of symptoms
其他诊断因素
- history of extracranial atherosclerosis
- history of cardiac disease
- unilateral symptoms
- dysphasia
- ataxia, vertigo, or loss of balance
- vision loss or visual field deficit
- binocular diplopia
- increased BP on presentation
- absence of positive symptoms (shaking, scotoma, spasm)
- family or personal history of premature stroke, miscarriage, or venous thromboembolism
- carotid bruit
危险因素
- atrial fibrillation
- valvular disease
- carotid stenosis
- intracranial stenosis
- congestive heart failure
- hypertension
- hyperlipidemia
- diabetes mellitus
- cigarette smoking
- alcohol abuse
- advanced age
- patent foramen ovale (PFO)
- inactivity
- obesity
- hypercoagulability
诊断性检查
首要检查
- blood glucose
- chemistry profile
- CBC
- prothrombin time, INR, and activated PTT
- ECG
- brain MRI with diffusion
- fasting lipid profile
需考虑的检查
- head CT
- erythrocyte sedimentation rate (ESR)
- telemetry/Holter monitor
- echocardiogram ± bubble study
- carotid Doppler ultrasound
- CT angiography
- magnetic resonance angiography (MRA)
- transcranial Doppler
- hypercoagulability studies
治疗流程
small-vessel TIA
cardioembolic TIA
stenosis of a major intracranial artery
mechanical heart valves or rheumatic heart disease already on therapeutic anticoagulation
撰稿人
作者
Lucia Chen, MD
Vascular Neurology Fellow
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
利益声明
LC declares that she has no competing interests.
Jennifer Simpson, MD

Associate Professor
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
利益声明
JS declares that she has no competing interests.
Karen Orjuela, MSCR, FAAN
Assistant Professor
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
利益声明
KO has received research funding from the Bristol Myers Squibb Foundation and Abbott.
鸣谢
Dr Lucia Chen, Dr Jennifer Simpson, and Dr Karen Orjuela wish to gratefully acknowledge Dr Ethan Cumbler, a previous contributor to this topic.
利益声明
EC declares that he has no competing interests.
同行评议者
Ronan Factora, MD
Staff Physician
Section of Geriatric Medicine
Cleveland Clinic
Cleveland
OH
利益声明
RF declares that he has no competing interests.
Tony Rudd, MD
Stroke Physician
Guy's and St Thomas' NHS Foundation Trust
Stroke Programme Director
Royal College of Physicians
London
UK
利益声明
TR declares that he has no competing interests.
参考文献
关键文献
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.全文 摘要
Turan TN, Zaidat OO, Gronseth GS, et al. Stroke prevention in symptomatic large artery intracranial atherosclerosis practice advisory: report of the AAN Guideline Subcommittee. Neurology. 2022 Mar 22;98(12):486-98.全文 摘要
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-418.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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