Stroke: transient ischemic attack.

The definitions of transient ischemic attack (TIA) and stroke have evolved with advancements in medical imaging. Approximately one-third of events that last less than 24 hours are associated with new infarctions on modern imaging sequences. These events, previously called apoplexy, are now called strokes. Approximately 10% of patients with TIA will have a stroke within 90 days without urgent evaluation and management; 50% of these events will occur within the first 48 hours. The ABCD(2) and ABCD(3)-I scores are validated measures that can help predict which patients are at greatest risk. With urgent evaluation and management, the rate of stroke after TIA can be reduced by up to 80%. Measures that reduce the rate of recurrence include rapid diagnosis and management of atrial fibrillation, identification and repair of carotid artery stenosis, early antithrombotic management, and use of statins for appropriate patients. Dual antiplatelet management with aspirin and clopidogrel may be useful in the first 30 days after TIA, but these drugs should not be used in combination after that time. Adverse events, including major bleeding and mortality, occur more frequently than with monotherapy with no reduction in ischemic events. Patients also should be encouraged to adopt lifestyle changes, such as regular exercise and weight loss.