The Eyes Don't Lie When It Comes to TIAs

Summary and Comment |
July 28, 2015

The Eyes Don't Lie When It Comes to TIAs

  1. Anne Cross, MD

A method to improve identification of patients with transient ischemic attacks in the emergency department

  1. Anne Cross, MD

The advent of diffusion-weighted magnetic resonance imaging (DWI) has revolutionized the diagnosis of acute stroke, but current brain imaging does not reveal transient ischemic attacks (TIAs). Within one week after a TIA, an estimated 3% to 10% of patients will have a stroke. However, the clinical diagnosis of TIA remains unreliable. Nondilated fundus photography has potential in this context because retinal vascular abnormalities are associated with stroke and TIA risk factors.

In the present study, researchers used nondilated fundus photography with a portable camera in 257 patients with focal neurological deficits who were evaluated in an emergency department for suspected cerebrovascular disease. Emergency physicians examined photographs for retinal vascular abnormalities (RVAs), including focal and generalized arteriolar narrowing. By this method, 56% of the 257 patients had RVAs, which was validated by masked interpretation of the photographs by neuro-ophthalmologists. The final diagnosis of stroke (27%) or TIA (73%) was based on a neurologist's review; stroke diagnosis required a positive DWI finding. Presence of focal or generalized arteriolar narrowing had high specificity (0.86) for TIA and stroke but relatively low sensitivity (0.31) and added independent information to the stroke and TIA predictive ability of the ABCD2 score (a composite score with components of age, blood pressure, clinical features, duration of deficit, and presence or absence of diabetes).

Comment

The ABCD2 score is often used in the setting of TIA to assess the risk for stroke within the next few days. The utility of the ABCD2 score may lie partly in its ability to discern true TIAs. This study suggests that the presence of both RVAs and elevated ABCD2 score may help differentiate TIAs from TIA mimics when the diagnosis is unclear. Importantly, this method could improve discernment of those who are at highest risk for stroke and in need of further intensive evaluation and monitoring.

Dr. Cross is Professor of Neurology and Section Head of Neuroimmunology, Department of Neurology, Washington University School of Medicine, St. Louis.

Citation(s):

Reader Comments (1)

Mutaz Tabbaa,MD Physician, Neurology, Bay Neurological Institute

the major problem with making diagnosis of TIA in the emergency room is the tendency to label every changes in mental status and labeling and every weakness or numbness, "TIA" I do not think Fundus photography which is not available in the emergency room Will add any extra benefit.this study only applies on the specific settings in the place where it was done.

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