TIA as Acute Cerebrovascular Syndrome

Patients during early period after the onset of transient ischemic attack (TIA) are at high risk of stroke. Therefore, TIA in acute setting should be recognized to be an emergency requiring immediate evaluation and starting treatment. There is no meaning to differentiate TIA in acute setting from acute ischemic stroke (AIS) only by the duration of symptoms. Acute TIA and AIS are on the same spectrum of acute ischemic syndrome in the central nervous system. The concept of acute cerebrovascular syndrome (ACVS), which includes acute TIA and AIS, is important for the recognition of TIA in acute setting to be a medical emergency as well as AIS.TIA patients with high clinical risk scores such as ABCD2 score, positivity of diffusion weighted image on MRI, intracranial or extra cranial arterial stenosis, multiple episodes of TIA, and hypercoagulability are at very high risk of subsequent stroke, and thus should be admitted. Dual anti platelet therapy in patients with non-cardio embolic TIA and direct oral anti coagulants in patients with atrial fibrillation may be useful for preventing early stroke recurrence. In patients with severe arterial stenosis and resistant to medical treatment, surgical or intravascular intervention may be necessitated. A TIA clinic might be very useful for immediate evaluation and management of acute TIA patients. The TIAregistry.org was conducted, which was an international multicenter cooperative prospective cohort study. Patients with TIA or minor stroke within 7 days of onset were recruited and followed up for 5 years. At 1 year, cumulative incidence of the composite outcome of stroke, acute coronary syndrome and cardiovascular death was less than half that expected from historical cohorts. The results of this registry suggest that urgent care for patients with a TIA or minor stroke either in specialized TIA clinics or dedicated care delivery units with stroke specialists undoubtedly works.