Drexel University College of Medicine, Philadelphia, PA 19127, USA.
Am Fam Physician. 2012 Sep 15;86(6):521-6.
Transient ischemic attack is defined as transient neurologic symptoms without evidence of acute infarction. It is a common and important risk factor for future stroke, but is greatly underreported. Common symptoms are sudden and transient, and include unilateral paresis, speech disturbance, and monocular blindness. Correct and early diagnosis of transient ischemic attack versus mimicking conditions is important because early interventions can significantly reduce risk of future stroke. Nonspecific symptoms and gradual onset are more likely with mimics than with true transient ischemic attacks. Transient ischemic attacks are more likely with sudden onset, focal neurologic deficit, or speech disturbance. Urgent evaluation is necessary in patients with symptoms of transient ischemic attack and includes neuroimaging, cervicocephalic vasculature imaging, cardiac evaluation, blood pressure assessment, and routine laboratory testing. The ABCD(2) (age, blood pressure, clinical presentation, diabetes mellitus, duration of symptoms) score should be determined during the initial evaluation and can help assess the immediate risk of repeat ischemia and stroke. Patients with higher ABCD(2) scores should be treated as inpatients, whereas those with lower scores are at lower risk of future stroke and can be treated as outpatients.
短暂性脑缺血发作定义为短暂的神经系统症状，无急性梗死证据。它是未来中风的常见且重要的危险因素，但严重漏报。常见症状为突然和短暂，包括单侧无力、言语障碍和单眼失明。正确且早期诊断短暂性脑缺血发作与类似病症非常重要，因为早期干预可以显著降低未来中风的风险。与真正的短暂性脑缺血发作相比，类似病症更可能出现非特异性症状和逐渐发作。突然发作、局灶性神经功能缺损或言语障碍更可能是短暂性脑缺血发作。出现短暂性脑缺血发作症状的患者需要紧急评估，包括神经影像学、头颈部血管影像学、心脏评估、血压评估和常规实验室检查。在初始评估期间应确定 ABCD(2)（年龄、血压、临床表现、糖尿病、症状持续时间）评分，有助于评估再次发生缺血和中风的即刻风险。ABCD(2)评分较高的患者应住院治疗，而评分较低的患者未来中风风险较低，可以门诊治疗。
