FRSM
09.05.2008, 11:05
Brain CT Findings Enhance Prediction of Stroke After TIA
CT findings honed the predictive ability of the ABCD score in an Italian cohort.
Transient ischemic attack confers a high short-term risk for ischemic stroke. The difficulty of identifying those patients with TIA who are at highest risk for early stroke has led to inconsistency in the management of patients with TIA. The recently developed 6-point ABCD score (Age 60 years = 1 point; Blood pressure 140/90 mm Hg = 1 point; Clinical features: unilateral weakness = 2 points and speech impairment without weakness = 1 point; and Duration of 60 minutes = 2 points or 10 to 59 minutes = 1 point) was shown to effectively stratify early stroke risk after TIA (see Journal Watch Neurology Feb 6 2007). However, more data are needed to ascertain this tool’s generalizability. These researchers prospectively followed a cohort of 274 patients with TIA who presented to emergency departments in Italy within 24 hours of symptom onset.
The ABCD score predicted stroke risk at both 7 days and 1 month. Higher scores (4) incrementally conferred a higher risk for subsequent stroke (those scoring <4 did not have strokes within 1 month). Adding CT imaging findings (evidence of white matter disease or cerebral infarct = 1 point) to create an ABCDI score bolstered prediction: Whereas an ABCD score of 5 or 6 conferred a 6-fold increased stroke risk at 7 days and 1 month (compared with a score of 1), an ABCDI score of 5 to 7 conferred an 11-fold increased stroke risk at 1 month (small numbers precluded statistical significance at 7 days).
Comment: Although some reports have shown that even patients with a low ABCD score may be at risk for early stroke, this study adds to the body of data validating the generalizability of the score. The improved prediction of stroke with the addition of CT findings must be validated, but it is promising, as CT is a widely available imaging modality. Indeed, any improvement in the ability to predict stroke risk after TIA (such as the ABCD2 score, which includes diabetes; see Journal Watch Neurology Mar 27 2007) will enhance the identification of patients with TIA who require prompt and intensive vascular risk reduction.
— Samir H. Shah, MD, and Bruce Ovbiagele, MD
Dr. Shah is Clinical Instructor, Stroke Center and Department of Neurology, University of California, Los Angeles Medical Center. Dr. Ovbiagele is Associate Professor and Director of the Olive View-UCLA Stroke Program, Department of Neurology, University of California, Los Angeles Medical Center.
Published in Journal Watch Neurology April 29, 2008
CT findings honed the predictive ability of the ABCD score in an Italian cohort.
Transient ischemic attack confers a high short-term risk for ischemic stroke. The difficulty of identifying those patients with TIA who are at highest risk for early stroke has led to inconsistency in the management of patients with TIA. The recently developed 6-point ABCD score (Age 60 years = 1 point; Blood pressure 140/90 mm Hg = 1 point; Clinical features: unilateral weakness = 2 points and speech impairment without weakness = 1 point; and Duration of 60 minutes = 2 points or 10 to 59 minutes = 1 point) was shown to effectively stratify early stroke risk after TIA (see Journal Watch Neurology Feb 6 2007). However, more data are needed to ascertain this tool’s generalizability. These researchers prospectively followed a cohort of 274 patients with TIA who presented to emergency departments in Italy within 24 hours of symptom onset.
The ABCD score predicted stroke risk at both 7 days and 1 month. Higher scores (4) incrementally conferred a higher risk for subsequent stroke (those scoring <4 did not have strokes within 1 month). Adding CT imaging findings (evidence of white matter disease or cerebral infarct = 1 point) to create an ABCDI score bolstered prediction: Whereas an ABCD score of 5 or 6 conferred a 6-fold increased stroke risk at 7 days and 1 month (compared with a score of 1), an ABCDI score of 5 to 7 conferred an 11-fold increased stroke risk at 1 month (small numbers precluded statistical significance at 7 days).
Comment: Although some reports have shown that even patients with a low ABCD score may be at risk for early stroke, this study adds to the body of data validating the generalizability of the score. The improved prediction of stroke with the addition of CT findings must be validated, but it is promising, as CT is a widely available imaging modality. Indeed, any improvement in the ability to predict stroke risk after TIA (such as the ABCD2 score, which includes diabetes; see Journal Watch Neurology Mar 27 2007) will enhance the identification of patients with TIA who require prompt and intensive vascular risk reduction.
— Samir H. Shah, MD, and Bruce Ovbiagele, MD
Dr. Shah is Clinical Instructor, Stroke Center and Department of Neurology, University of California, Los Angeles Medical Center. Dr. Ovbiagele is Associate Professor and Director of the Olive View-UCLA Stroke Program, Department of Neurology, University of California, Los Angeles Medical Center.
Published in Journal Watch Neurology April 29, 2008