ESOC 2019: Trainsient Ischemic Attack

The session trainsient ischemic attack took place at 14.45-16.15. The chairs were Prof Marcel Arnold and Prof Ursula Schulz. The first talk was transient neurological attacks are they actually TIAS? Prof Ewoud van Dijk mentioned nonfocal transient neurological attacks (TNS) has 23% DWI lesions whereas TIAs has 31% DWI lesions. Majority of these lesions in TNS are multiple small lesions. And confusion and isolated hemihypoesthesia are the most common symptoms. 1/3 of patients has transient cognitive impairment after TIA and increased 5 year risk of dementia. The second speaker was Prof Werner Hacke with the topic TIA as a marker of future vascular risk in AF. He focused that in newly diagnosed AF patients a history of TIA is associated with an increased risk of one year mortality and stroke. This excess risk is almost exclusively attributable to a history of stroke or a history of both stroke and TIA while history of TIA only is a much weaker predictor. This weak predictive power of history of TIA is probably caused by the low reliability of establishing the diagnosis of TIA retrospectively specifically if the diagnosis is made by non neurologists.  Every practice most AF patients are evaluated by non neurologists who may have difficulties in diagnosing TIA. He mentioned a newer risk calculator such as Garfield AF risk score that only assess a history of stroke may be preferable to the old risk scores.

Prof Kristina Szabo talked about Imaging in suspected TIA how much is needed? Retrospective US study in 2017 done by Chatarvedi on 7889 patients reported that 85% of the patients had CT or MRI only within 2 days of TIA and 49% had only CT. Increased odds of CT performance is older than 80 years, prior stroke and history of AF , but CT is unremarkable in 90% of patients. Increased odds of MRI performance is diplopia, symptom duration more than 6 hours. But also the percentage of clinical diagnosis of TIA with diffusion weighted MRI is 30-70%. DWI positive patients in TIA have higher rate of prior AF or AF diagnosed during the hospital stay. She mentioned that DWI positivity and vessel pathology convey useful. When MRI is not avaliable non contrast CT plus vessel imaging are alternative methods of choice. Use whichever techniques are more quickly available at your institution.

The next speaker was Prof Eleni Korompoki with the title of screening for AF after TIA. The prevalence of AF in TIA patients is 0-27%. Almost 50% of TIA has undetermined etiology. Recommendations for prolonged monitoring after TIA is needed even prolonged event recording rarely performed (16%). AF detection rate in unselected TIA patients is 3% and in selected TIA patients is 7%, detection rate of AF is higher in selected patients with TIA. AF prevalence in TIA increases with age. Prospective studies are needed to inform patient selection, optimal timing and duration of monitoring specifically in TIA patients.

The last speaker was Prof Pierre Amarenco talked about long term outcome following TIA. Contemporary long term risk is 12% with steady increase after 10 days.  Disabling stroke risk is 8% at 5 years. Stroke patients with ipsilateral atherosclerotic stenosis have higher absolute risk than the others.